HomeMy WebLinkAboutX2022-1543 - Permit Application,�_0 -2- -1 I S"LP,3
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Worksheet for Combo Building & Solar Permit ApplicationGO'
L,Comm'I
C�iesidential City of Newport Beach - Building DivisionNOTE:
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
CIf6building
[I Grading []Drainage CElec CMech plum Cu YdCut
Cu Yd Fill
F-1
Project Address (Not mailing address)
❑ Flood C Fire 0 Liq C Landslide
CIN/A Floor
Suite No
Description of Work
6Ar1-t
New/Add SF E7771
OWNER'S NAME Last
/ice /Z—
ICe 619, j
�VA71'4,
lAt del SF i 9
Glu
Garage/New/Add
First I,
Use�ConstType V
# Stories #Units (if Res)
Valuation
Material/Labor
Owner's Address ..
Address
City --- State
Zip Telephoned
APPLICANT'S NAME Last,vA f First
A f
Applicant's Address Applicant's E-mail Address
Q!'Lt
City X+G/�pes SC.%t.'{� I Statei � ' � Zip q�r7 2 Telephone
ARCHITECT/DESIGNER'S NAME Last
Firstz-/�q/,OL l Lich
7 25
Architect/Designer's Address Architect/Designer's E-mail/Address
Zip
ENGINEER'S NAME Last
First Lic. No.�'
Engineer's Address Engineer's E -ma
E-mailAddress
City State Zip �� Telephoned
CONTRACTOR'S NAME/COMPANY
Cgill7 Vct t Lic. No.C(567�13 Class )�
Contractor's Address
City State I
--7 �—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
Contractor's E-mail Address
ZIP �� Telephoner)
PERMIT NO,
PLAN CHECK NO.
PLAN CHECK FEES $