HomeMy WebLinkAboutPV2022-0284 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r- Residential
City of Newport Beach -Building Division ?,A6-rL-z>q84
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building F_ Grading f—Drainage F_ Elec Mech F- Plum Cu Yd Cut F_ Cu Yd Fill F_
Project Address (Not mailing address) f Flood F_ Fire F_ Liq Landslide FN/A Floor 7Suite No
.. . ..... ...
Description of Work
Use F_ Const Type
# StoriesF_ # Units (if Res)
---------- ----------------
Valuation $ &
Material/Labor
New/Add SFF-- Remodel SF
Garage/New/Add
OWNER'S NAME Last iiFirst
Owner's Address
Owner's E-mail Address
e -
V53D
City State
_q
zip Telephone
_q75 6V
F A
APPLICANT'S NAME Last
First L/ I'v
Applicant's Address
Applicant's E-mail Address
(OW
City State
7 Zip Telephone .
ARCHITECT/DESIGNER'S NAME Last
— First F_ Lic. No.
.. .........
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
tIfne
zip
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State F_
.. .. __ . .
zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City State
,
zip q7_7 If-GTelephon e
(ki
SETBACKS REAR SETBACKS FRONT
TA V11
PERMIT NO. 0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO,
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $