HomeMy WebLinkAboutXR2022-2039 - Permit ApplicationPrint Form
I Worksheet for Combo Building & Solar Permit Application -Comm'] Al
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r F�esidential City of Newport Beach -Building Division V,�'1.C1SL
NOTE: PLAN CHECK FEES DUE AT TIME OF S 6�
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F-Building Grading rry, Drainage Elec r Mech F— Plum Cu vd Cut s— Cu Yd Fill F_
Project Address (Not mailing address) F Flood r Fire r Liq r Landslide I —N/A Floor Suite No
Description of Work
Use ConstType NO
# Stories # Units (if Res)s
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New/Add SFs-- Remodel SFs--
Garage/New/Add �
Valuation 75k
Material/Laabor
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
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City r/II/P/Z7 State �— ZipI — Telephone
APPLICANT'S NAME Last1,{/t�J'0l f First KFViIJ
Applicant's Address Applicant's E-mail Address
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City [TAP 7vr�IVI�-i� State �i Q Zip (116c� Telephone % 7� 760c
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F__ Zip [-Telephone
ENGINEER'S NAME Last �(:'�'jt-�7 _ First �4M Lic. No.
Engineer's Address Engineer's E-mail Address
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City �r\t�lA/ State (_�Ij Zip U( Z� Telephone �j�� ��� 7"! 2-7CONTRACTOR'S
NAME/COMPANY Lic. No. Gf�yU/�S
1�1�1 /\MOJnE>-j/vE Class
Contractor's Address Contractor's E-mail Address
46E12 ll
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City State CA ZiP � q�6 y, Telephone 7 / h'1,s I �_, e C
SETBACKS REAR SETBACKS FRONT PERMITNO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Fa 20Z 2. 1270
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $