HomeMy WebLinkAboutX2022-1117 - Permit ApplicationPrint Form- 1 Worksheet for Combo Building & Solar Permit Application o���WP°Rr
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City of Newport Beach -Building Division
Comm'I Residential `u
r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Oy�t
Iding j_ Grading F-Drainage F_Elec F_Mech F- Plum CuYdCut CuYdFill _—
Project Address (Not mailing address) F_ Flood F_ Fire f— Liq Landslide I_N/A Floor Suite No
F� D P, C) �� - 0 o I I
Description of Work
Use F�Wv) Const Type
# StoriesFF # Units (if Res)F_
man
WV
Valuation $
Material/Labor
New/Add SF Remodel SF�O Garage/New/Add f -.
OWNER'S NAME Last ��� ���'(,- First��
Owner's Address Owner's E-mail Address
City �j`1�1 O0 -t_ U/ if KO-_� State ��G�
Zip I l - Telephone �Vff �;
APPLICANT'S NAME Last �j;�fj� First
Applicant's Address Applicant's E-mail Address
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City ��Ls1'r` State Zip �p Telephone ��( S
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �` Zip Telephone
ENGINEER'S NAME Last FirstLic. No.
Engineer's Address Engineer's E-mail Address
City }� �%C�/t L State ��� Zip '� 5 Telephon c\ _�
CONTRACTOR'S NAME/COMPANY Lic. No.-� Class®
Contractor's Address V'COtractOr'S E-mail Address
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City to Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. o
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $