HomeMy WebLinkAboutXR2022-2245 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application
j- Comm'I Residential City of Newport Beach - Building Division y�r6 1e
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL/\ �P
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Building i- Grading'brainage r Elec r— Mech F— Plum Cu Yd Cut F
Cu Yd Fill
_. _ ..
Project Address (Not mailing address) f- Flood j- Fire r- Liq F_ Landslide F_N/A Floor Suite No
Description of Work Use F—Const Type F_
}} # StoriesF # Units (if Res)[
......... __ _
Valuation $
New/Add SFF---- Remodel SF Ga age/New/Add Material/Labor CXD
OWNER'S NAME Last � First
Owner's Address Owner's E-mail Address
CitY ✓ State Zip a Telephone -7 1 N
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State �— Zip TelephoneF.
ARCHITECT/DESIGNER'S NAME Last 1 �First C � � � � 1e--- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
_...._ _ CGvn e.. 4��SCcedes� ►� C�
City 5k-z 6Aj Sa State �(�- Zip cj,�_� Telephone O r? _7V . 579
ENGINEER'S NAME Last First Lic. No
Engineer's Address Engineer's E-mail Address
City State Zip �® Telephone
SETBACKS REAR IF SETBACKS FRONT PERMIT NO. ) OO'Z, Z _ 0 7
SETBACKS LEFT (� SETBACKS RIGHT PLAN CHECK NO.
USE ZONE �— Wyb DEVELOPMENT NO PLAN CHECK FEES $