HomeMy WebLinkAboutX2022-1024 - Permit ApplicationKZDZZ-1n24
Print Form Worksheet for Combo Building & Solar Permit Application o��EW{Rr
F" Comm'I Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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[—Building F Grading F—Drainage j_ Elec r`Mech r Plum CuvdCut l CuYdFill F
Project Address (Not mailing address) F_ Flood F Fire F_ Liq j— Landslide f_N/A Floor Suite No
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Description of Work
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Valuation $
New/Add SF( RemodelSF1 J Garage/New/AddIr Material/Labor 661000
Use Const Type FV6
# Stories) `3 # Units (if Res)l
OWNER'S NAME L/
Last First
Owner's Address Owner's E-mail Address
City ���� State Zip Telephone '
APPLICANT'S NAME
Last First
Applicant's Address Applicant's E-mail Address
City /, State Zip �� Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.®®�
-�'" 1
Arch itect/Designner's -Address C / Arch itect/Designer's E-mail Address
ty � .� zip v
ci — --- State p Tel e t �/ �`�� / p t-7�.__ Cr_y__�TjV
ENGINEER'S NAME Last First W Lic. No,1—
Engineer's Address Engineer's E-mail Address
City State �— Zip Telephone)
CONTRACTOR'S NAME/COMPANY n Lic. No. (� y 7�j�� Class _y '
Contractor's Address Contractor's E-mail Address
City State ��` Zip Tele hone / �y0
I p�7C� ---! p cal /`
SETBACKS REAR SETBACKS FRONT PERMIT NO. c dZ /
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.