HomeMy WebLinkAboutX2022-0993 - Permit ApplicationPrint Form � Worksheet for Combo Building & Solar Permit Application @S72,Comm'I City of Newport Beach - Building Division
n j Residential A NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
;wilding i—j Grading j7Drainage [i Elec i—I, Mech F-PlumCu yd Cut Cu Yd Fill
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Project Address (Not mailing address) 1-! Flood F-1FireF7,Liq n Landslide i jN/AFloor Suite No
22 S 1, ----------
Description
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Description of Work Use I 1 Const Type
# Stories # Units (if Res)n
Valuation $ J,
New/ i5 � �Remodel SF � i Garage/New/Add �� Material/Labor qWj 5 0�
OWNER'S NAMELast I _ >. First W
Owner's Address
22 4
City I- A IQ�f.7__ State
APPLICANTS NAME Last
Owner's E-mail Address
__UV - I Zip
Applicant's Address
I
City State
First
Applicant's E-mail Address
Zip -- -------- Telephone
F__
NAME Last First
-- -- -- -- - --I Lic. No.
Architect(Designer's Address
------ -- --- - _ ----
city State '
ENGINEER'S NAME Last
Engineer's Address
CityCJi - -- State—,
Architect'Designer's E-mail Address
Zip [77 Telephone—
FirstF Lic. No.C 4
Engineer's E-mail Address
-
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Zip 1 Z6 Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class Fl
Contractor's Address
City State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
ZIP —i Telephone
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $