HomeMy WebLinkAboutXR2022-3016 - Permit Applicationrint Form Worksheet for Combo Building & Solar Permit Application
FCo-Comm'l FTAesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OFqLJRMIA
F—vBuilding F_ Grading F-Drainage F_ Elec Mech F— Plum Cu Yd Cut Cu Yd Fill
F F F
Project Address (Not mailing address) f— Flood Fire f7 Liq F_ Landslide F_N/A Floor Suite No
7
T—S/ 7
Description of Work t��,,A 7,-_eyL_ < —o /L e) --(,/
Use
9 ConstType
7
# Storiesj'!�� # Units (if Res) �7�' /,
/V ...... _6 ... . . ..... A I:
New/AddSFI..., Re ad e I SF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME Last C"O First
. . .... ..... -
Owner's Address Owner's E-maJ.I_Address___
City State
.. . ... ....... Zip Telephone
APPLICANT'S NAME Last x First -
>c I
. . .. I .. - - . C__-)A
Y
Applicant's Address Applicant's E-mail Address
City 1Dloe golf) State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last[ First Lic. No
xf 7
Architect/Designer's Address Architect/Designer's E-mail Address
City 1-7-7 ___ 21P Telephone
ENGINEER'S NAME Last First Lic. No. r
Engineer's Address Engineer's E mail Address
City State F Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK 2,0,— 'Zf -75
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $