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HomeMy WebLinkAboutXR2022-1849 - Permit ApplicationXR 2 a zz ► �9 Print Form Worksheet for Combo Building & Solar Permit Application `R:o Comm'I r- Residential City of Newport Beach - Building Division1' NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i-Building F_ Grading r-,Drainage r lec F Mech ( ` Plum co vdcutF— Cu Yd Fill I Project Address (Not mailing address) r Flood F_ Fire r" Liy (- Landslide FN/A Floor Suite No Description of Work Use Const Type f ( N c' # Storiesr ,' , # Units (if Res)f 4MYi CtA�y � � f�14\� �1�� Valuation $ ey Material/Labor �— New/Add SF� Remodel SFF—_ Garage/New/Add F___ OWNER'S NAME Last �T'/� j ��p J First Owner's Address Owner's E-mail Address -dress{— catlP_ City F_t State f -_di; Zip TelephoneF_ ) ` -i APPLICANT'S NAME Last 9 First �G �\ Applicant's Address b� >, d. C �'� Applicant's E-mail Address J_ _`{.. City a State Zip r Telephone 5�(:)�_ - ARCHITECT/DESIGNER'S NAME Last First( _ I �6� LicNo.I�__�__ AichitectlDesigner's Address Architect/Designer's E-mail Address [µ `a L4 S l M U E L /a �AcKI�SI (�e 9 rUI A y I L. C© Y City •1 .a.�,y State � Zip F qQ�)qa Telephone�I Lk -_'A0- 1) () j l ENGINEER'S NAME LastV� -- First Lic No.� Engineer's Address_ Engineer's E-mail Address City State Zip Telephoned CONTRACTOR'S NAMEXOMPANY F ` C Lic No. (aH1.4,1SClass IVD Contractor's Address �J 'I(i'��j-{_ Cl \lei`\ Ir- 1, l� ntractor's E-mail Address_ C �U-N �� @ co?C. Ni err City I 'Vi1SSlO N U1eS0� State Zip �a.(pc(a Telephone�C(L� SETBACKS REAR SETBACKS FRONT PERMIT NO.L� SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, C'2oZOVIO ' USE ZONE DEVELOPMENT NO PLAN CHECK FEES S C-IFC