HomeMy WebLinkAboutX2022-1479 - Permit ApplicationPrint Form j Worksheet for COMM Building & Solar Permit dAppiicat!on
F_Comm'I F_Residential City of Newport Beach -Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF auRMITTAI tNlrn)_- VA
rBuilding F_ Grading f—Drainage F_Elec rMech F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use F ConstType r--
# Stories # Units (if Res)
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New/Add SF�` Remodel SFF -- Garage/New/Add F_—
Valuation $
Material/Labor
OWNER'S NAME Last— ��
�f \!./V, First
Owner's Address Owner's E-mail Address
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City �l.v\J State C JL ZL��
P G Z�1�\ Telephone i}.�ti
APPLICANT'S NAME Last First J ul� r- u
Applicant's Address Applicant's E-mail Address
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City ; i w, cV U'� State Zipc. Telephone '11.�.� C1,
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City p ' i \ State Zip �Z Telephone[";, y �� 'tL 7 - }
ENGINEER'S NAME Last �� ,1.✓ ( L First Lic. No. F
Engineer's Address Engineer's E-mail Address
City State �� zip! TelephoneF_
CONTRACTOR'S NAME/COMPANY LZLGLic No. l Class
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Contractor's Address Contractor's E-mail Address
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City F7, _\ V.� A-17 A, State � � ZiP � "� (}i_� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE DEVELOPMENT NO P�LANNHWEES $