HomeMy WebLinkAboutPV2022-0375 - Permit ApplicationL Print > orm�J Worksheef for Combo Building & Solar Permit Application o�"EWp°a� .
r Comm'I r Residential City of Newport Beach -Building Division v ?,®22� 431
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM TTAL
F—Building F Grading f—Drainage r Elec F" Mech Plum Cu Yd Cut F_
Cu Yd Fill F_
Project Address (Not mailing address) [- Flood r Fire f— Liq f— Landslide F N/A Floor Suite No
Description of Work Use F Const Type
C�� JJ0 13 1� ��r",z # Stories # Units (if Res)s—
New/Add SF Valuation $ Remodel SF Garage/New/Add �� Material/Labor I ��, i>� l�
OWNER'S NAME Last r '
_.... �.V\l/\ First
Owner's Address �" Owner's E-mail Address
9 U Q C �I e_?. I Vl �l ly _
cityW�.�C��C .__. State p
- _ _- - - _ _ _ Zip `� � O Telephone
APPLICANT'S NAME Last ++
�C_I. First
Applicant's Address
_ Applicant's E-mail Address
City State F Zip F® Telephones—
ARCHITECT/DESIGNER'S NAME Last First
_ Lic. No.
Arch itect/Designer's Address Architect/Designer's E-mail Address
-- -
City State Zip Telephone
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address 7s) 7
City State F Zip �— Telephone
CONTRACTOR'S NAME/COMPANY (M-b(An ( vifC + ar Lic. No. Class
Contractor's Address Contractor's E-mail Address
City _ State C _ _ Zip j t � 7 (? 3 Telephone
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. FV tr&-Z — 0 �7
PLAN CHECK NO.
PLAN CHECK FEES $