HomeMy WebLinkAboutXC2022-1960 - Permit Applicationprint Form VVorksheet for Combo Building & Solar Perrot Application
city of Newport Beach - Building Division 0,
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(� Comm'I [� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUB TTAL
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Grading FDrainage jr Elec
Mach Plum Cu Yu
cut Cu Yd Fill
r"Building
Fire Liq r Landslide �N/A Floor Suite
Project Address (N®4 a�aailiaag address) (✓ Flood fF_
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Use Const Type
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Description of Work
# Stories? # Units (if Res)?
- - Valuation
Remodel SF
Garage/New/Add Material/Labor
New/Add SF _._
IFirst
OWNER'S NAME LastF � v,
Owner's E-mail Address
Owner's Address
State Zip �— Telephone
City
ic.•�
APPLICANT'S NAME LastF -4 -
Applicant's E-mail Address
Applicant's Address
- - Telephone
State Zip
City _ . .
First Lic. No.
ARCHITECT/DESIGNER'S NAME Last 15 _ _
J
Architect/Designer's E-mail Address
Architect/Designer's Address
Telephone
State FZip
City _ __
First
Lic. No.
ENGINEER'S NAME Last - -
Engineer's E-mail Address
Engineer's Address
..........
Telephone
State F Zip �--
City _ _ _
/lit Lic. No. Class
CONTRACTOR'S NAME/COMPANY
Contractor's E-mail Address
Contractor's Address /
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Telephone �e// g,�;g-2��%7/S`
F�_- / State r (,� Zip 5���� ; CP_0 �G8.271 2717
CitY / iT,L �-rj ll, ,.e
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
PLAN CHECf�. v
SETBACKS LEFT SETBACKS RIGHT �/ `Cv_
USE ZONE DEVELOPMENT NO
41 N CHECK FEES $