HomeMy WebLinkAboutXC2022-2040 - Permit ApplicationL Print Form_) Worksheet for Combo Building & Solar Permit Application
r Comm', j eR' sj entiaY ZZ 20'�6 City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building f- Grading F-Drainage `_Elec FMach Plum j�
Cu Yd Cuts Cu Yd Pill
Project Address (Not mailing address) [ Flood F_ Fire F_ Liq F_ Landslide F_N/A
Floor
)escription of Work
M&M
Suite No
I
Use ConstTypes
# Stories # Units (if Res)s
Valuation -
New/AddSF�— Remodel SF Garage/New/Add — Material/Labor 7_5 LOC
OWNER'S NAME Last f
{Js_c First 7/,l%/�S(
Owner's Address
Owner's E-mail Address
City State ZIP �— Telephoned
APPLICANT'S NAME Last r First
Applicant's Address Applicant's E-mail Address
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City State =f Zip .? ✓"v Telephone Li -
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ARCHITECTIDESIGNER'S NAME
Last �c,l�q: First:f, Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City -a " r. State ZiP r' ZL Lb TelephoneF/ TS' fJ �7
ENGINEER'S NAME Last M
ANSt1An�
Engineer's Address
City J a ; P ,ti State ( r7
First I f A,{ I A Lic. No.s—
Engineers E-mail Address C J (7 7lJ
Zip 7L i l Telephone 771H j ✓-L`�
CONTRACTOR'S NAME/COMPANY I F— ClassF_
Lic. No.
Contractor's Address Contractor's E-mail Address CS> 1
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City f l JS Fc N State C,� ZiP l -" � Telephone cr �' - 723 ` O)y
SETBACKS REAR SETBACKS FRONT PERMIT NO. 'x, Zs_ .7-
- C�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. C-
USE ZONE DEVELOPMENT NO1-7rJ PLAN CHECK FEES $