HomeMy WebLinkAboutX2022-0229 - Permit Applicationmiz- voA
.HEEDEHEED Worksheet for Combo Building & Solar Permit Application
Comm'I ❑Residential City of Newport Beach - Building Division z )�
'-' NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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,building ❑Grading ❑Drainage Pl Elec [�(Mech 'lum �
Cu Yd Cut Cu Yd Fill I j
Project Address (Not mailing address) C Flood ❑ Fire [] Liq [ Landslide F�/A Floor j Suite No
,Al�v /� 1�51S p F_ ( -P> 3
V fV F
New/Add SFr— Remodel SF �j 1, Garage/New/Add ��
OWNER'S NAME Last
First
Use 1 phh`klconst Type
# StoriesW3 # Units (if Res)E]
Valuation Material/Labor
U —�
Owner's Address r
Owner's E-mail Address
City _- '��� f State Zip I `7 YT ► f i Telephone
j APPLICANT'S NAME Last I First i-
Applicant's Address t
City (��� _ State L_
I
Applicant's E-mail Address
Zip q Z f97, Telephone Z �V >0
ARCHITECT/DESIGNER'S NAME Last 7
!� 1� �'j%il'.I� ._� First
Architect/Designer's Address
City Lj �K/lv�% State (/
Lic. No.
Architect/Designer's E-mail Address
I
Telephone (06CHI.
ENGINEER'S NAME Last - V First _ _ ( Lic. No.�— - )
Engineer's Address
City State
i
Engineer's E-mail Address
Zip Telephoned--y
_I
CONTRACTOR'S NAME/COMPANY [77j� —I j Lic. No.FeA 01
Class ( �� I
Contractor's Address
SC7t `��vt C
City of ",s-Pa e-1- vc State
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Contractor's E-mail Address
I
ZIP Telephonef_!K7r `-C/
=- -
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
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