HomeMy WebLinkAboutXR2022-2744 - Permit ApplicationL_fri2�tForT_j Worksheet for Combo Building & Solar Permit Application I-
Comm'I dResidential City of Newport Beach - Building Division y�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL x
wilding l- Grading F-Drainage C- Elec F_ Mech Plum Cu Yd Cu[F_ Cu Yd Fill
Project Address (Not mailing address) F_ Flood ( Fire [7 Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use F Const Type
ofl,Vw Gam-
# Stories # Units (if Res)F—
•
New/Add SF F— Remodel SFFT i�— Garage/New/Add F__
Valuation$
Material/Labor
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OWNER'S NAME Last %L S� n ` o-ZE ALL. First
Owner's Addrre7ss Owner's E-mail Address
City VC u Lam, 1� �� r h State ETA ZIP _ �i �4,,- Telephone—
APPLICANT'S NAME Last ' First
Applicant's Address Applicant's E-mail Address
City < < State F Zip Telephone _
ARCHITECT/DESIGNER'S NAME Last First—
Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip �— Telephoner
ENGINEER'S NAME Last First Lic No.F—
Engineer's Address Engineer's E-mail Address
City r®_ State I— Zip �— Telephoner
CONTRACTOR'S NAMEXOMPANY C � 3d�1 —�
-ram Lic. No. �� Class
%?��r
/G�I� ConSNuLYr�l
Contractor's Address Contractor's E-mail Address
City y n Li n2< State G Iq ZIP �,� Telephone ]/ /)S' _ d•
SETBACKS REAR SETBACKS FRONT PERMIT NO. XV %ozz-J j
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $