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HomeMy WebLinkAboutX2022-1500 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit n Application City of Newport Beach -Building Division o CommI r Residential x kn- l✓v� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL l✓w G<Foa+ rBuilding -Drainage 'lec Mech Cu yd cut lllCu Yd Fill Project Address (Not mailing address) r Flood r; Firer Liq �', Landslide rN/A Floor Suite No Description of Work Use F7I Const Type �! - # Stories # Units (if Res) Valuation $ New/Add SF�j Remodel SF�i Garage/New/Add F7777 Material/Labor i OWNER'S NAME Last First ----- F-- Owner's Address Owner's E-mail Address City State �J Zip[ Telephone - - - - - - APPLICANT'S NAME Last[ q be f j First Applicant's Address -311 �_ j`�1 ,N City 7U) y�� DA - p - State Applicant's E-mail Address �C41 o� Zip Telephone 7_[� ARCHITECT/DESIGNER'S NAME Last �— First Lic No. J i Architect/Designer's Address City r StateI Architect/Designer's E-mail Address Zip i Telephoned ENGINEER'S NAME Last First Lic No Engineer's Address - - - - City State F Engineer's E-mail Address Zip ��i Telephoned CONTRACTOR'S NAME/COMPANY i of p� C Lic. No. * `/g 2 '�{ Class Gy 6 - Contractor's Address City vv� cv vYCJL - State C SETBACKS REAR SETBACKS FRONT SETBACKS LEFT SETBACKS RIGHT Contractor's E-mail Address Zip 's. ©, .�- Telephone�( � r f '� Z PERMIT NO. PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $