HomeMy WebLinkAboutX2022-0558 - Permit ApplicationPrint Form aEW�Rr
Worksheet for Combo Building &Solar Permit Application o� a�
City of Newport Beach - Building Division �^
[ Comm'I CI Residential �CIF NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 65V u x
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�j�' Building ❑Grading ( Drainage j� Elec [�; Mech olf-Plum cued cut Cu FillF7
Project Address (Nat railing 'address) Flood [Fire r i Liq ❑Landslide r N/A ` Floor Suite No
Description of Work ' iZ,19— k, m6htsj mow` .
Use ConstType
# Stories:, # Units (if Res)
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Valuation $
Material/Labor
New/Add SF Remodel SF� G r ge/New/Addi
OWNER'S NAME Laster first
Owner's Address Owner's E-mail Address
City 1 (-'�bi�l State Zip Telephone 1411 - 446 '®p _
APPLICANT'S NAME Last �(}S� First Wis J
Applicant's Address Applicant's E-mail Address
City N t W� State i Zip �Z � 1 Telephone t ' �✓%E t'o�U
ARCH ITECT/DESIGNER'S NAME Last _ FirstF_ Lic. No. j
Architect/Designer's Address Architect/Designees E-mail Address
I
cityState Zip Telephone
P ,
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address. Engineer's E-mail Address
I
City - _ State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic: No.
L (S GA2 Go �'`7f35'I.Class
Contractor's Address Contractor's E-mail Address
City State. Zip r� Telephone��. - ----
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $