HomeMy WebLinkAboutXR2022-2588 - Permit ApplicationWorksheef for Combo Building ---_Print-Form � g & Solar Permit Application
City of Newport Beach - Building Division `)
(� Comm'I (� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �c'
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r—Building F_ Grading `Drainage F_ Elec F Mech F— Plum Cu Yd Cutl Cu Yd Fill F_
Project Address (Not mailing address) [ Flood r Fire F7 Liq [_ Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type F
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# Stories[ # Units (if Res)
Valuation $
New/Add SF Remodel SF Garage/New/Add r� Material/Labor I , t�A '
OWNER'S NAME Last n
First ••
Owner's Address Owner's E-mail Address
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City State F
Zip [77777 Telephone
APPLICANT'S NAME Last ��-��-y� —�� First f C C
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Applicant's Address Applicant's E-mail Address
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City _fj_.__.. -_ .. __ State ZipF; �z
Teleph ne
ARCHITECT/DESIGNER'S NAME Last First _ �r
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Architect/Designer's Address Architect/Designer's E-mail Address
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city
State Zip Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone
CONTRACTOR'S NAME/COMPANY 1 � j� A�elli h_1 �. I� NOS 8 ( ,,Z�•.!. Lic. No. Class I /.J
Contractor's Address L Contractor's E-mail Address
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City iJ State G Zip �� au i
p q Z Z Telephone t 6 ��2 '
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. A?-t.-jJqK
PLAN CHECK NO.
PLAN CHECK FEES $