HomeMy WebLinkAboutXR2022-3190 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Perm Application
City of Newport Beach -Building Division
2Z Comm'I �ResidentialZ
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB I AL 1
V4uilding F-Grading F-"Drainage F-Elec F_'Mech F`Plum Cu vd Cuts Cu Yd Fills
Project Address (Not mailing address) F- Flood F- Fire F- Liq r Landslide [N/A Floor Suite No
CA Ar-
Description of Work
Use�v Const Type �/�
# Stories # Units (if Res)
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Valuation 3I
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Material/Labor
New/Add SF � Remodel SF � Garage/New/Add �
OWNER'S NAME r/ ty� Last First
Owner's Address ��V Owner's E-mail Address
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City �y 07,D A(iL State �- ---- Zip G%.yQj Telephone
APPLICANT'S NAME Last First
Addre
Applicant's Address Applicant's E-mail
City �C/d - C�OLA.I./V - _ -. State Zip 4/ 9_- Telephone 9��ss9
ARCHITECT/DESIGNER'S NAME Last First 7 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephoned
ENGINEER'S NAME Last / ^ -• I/IW L(j First `i-fl At ti Lic. N . �J �4
Engineer's Address Engineers E-mail Address
ear
City ( ( N7^fL( State s� Zip 9237 0 Telephone j z6 —
CONTRACTOR'S NAME/COMPANY Lic Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip F Telephones
SETBACKS REAR SETBACKS FRONT PERMIT NO. , \VV 1'
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $