HomeMy WebLinkAboutPV2022-116 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
rl Comm'] (-, Residential City of Newport Beach - Building Division -,NW72-1' 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage [-Flet r Mech !Plum Cu Yd Cut �l Cu Yd Fill
Project Address (Not mailing address) ❑ Flood rj Fire �j Liq r Landslide I_ N/A Floor Suite No
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Description of Work
Use�i Const Type
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# Storiesf.'77,l # Units (if Res)'
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Valuation
Material/Labor
New/Add SF�— Remodel SFGarage/New/Add �—i
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OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City _ Vry( C/ :t _ /U _ State Zip I Telephoned
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APPLICANT'S NAME Last r - FirstSC�
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Applicant's Address Applica/n`t's E-mail
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VV._ 4 _ - �J° r� - --I _ Ol. _ *La�4,�_T 0CityI
(_ v�i(�(� State I ` '� Zip CJ Teleph
ARCHITECT/DESIGNER'S NAME Last I First Lic No
Architect/Designer's Address Architect/Designer's E-mail Address
City State F-7 Zip F Telephone) --
ENGINEER'S NAME Last � i G First_- ( I.R (+,7 Lic. No. J
Engineer's Address Engineer's E-mail Address
City State t Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class �Q
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Contractor's Address 's
E-mail Address
Contractores s
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City ��U I �� State (�Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $