HomeMy WebLinkAboutXR2022-2447 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
(� Comm'I residentialCity of Newport Beach -Building Division X� Z_2_' lio
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ZL� Z4 12
F-Building Grading rainage r Elec Mech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (loot mailing address) Flood Fire F_ Liq F_ Landslide F_N/A Floor Suite No
�� - _ r.. c 55 _ _ Fes_- F
Description of Work f/414
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Use F— Const Type
# StoriesF_ # Units (if Res)F_
Valuation $ '
Material/Labor (��L
New/Add SF Remodel SFGarage/New/Add FV
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
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e
City ��',�} State �� Zip �— Telephone
APPLICANT'S NAME LastFirst
Applicant'sAddress Applicant's E-mail Address
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City S
�,) State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Arr�chittect/Designer's Address Architect/Designer's E-mail Address
C ity �'
-� State Zip . Telephone
ENGINEER'S NAME Last First F Lic. No,
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO �� PLAN CHECK FEES $