HomeMy WebLinkAboutXR2022-3190 - Permit ApplicationPrint Form ; Worksheet for Combo Building & Solar Permit Application
Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F- Grading F—Drainage F_ Elec r Mech r Plum CuYdCut F CuYdFill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide F_N/A Floor Suite No
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` j 1 A..J 2G- t
Description of Work
Use Const Type F�
2e G �o�rrR P .—
# Stories #Units (if Res)
(11
New/Add SF� RemodelSF� Garage/New/Add
Valuation $
Material/Labo 7,
OWNER'S NAME Last }` First
[
Owner's Address Owner's E-mail Address
&/ ,., lei_ f
City C
0 State Zip F— TelephoneF_
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APPLICANT'S NAME Last / `r ` First `' A U
Applicant's AddressApplicant's E-mail Address
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UC7 d G.5G V�-W Cd a
City (/✓�5�State C`4—_. Zip �l`<Z% Telephone %Y` 227;—�Y"°
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ARCHITECT/DESIGNER'S NAME "`--
Last First Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
City State �� Zip F_ Telephoned
ENGINEER'S NAME Last First F_ Lic. No.F-
Engineer's Address Engineer's E-mail Address
City State F_ Zip [_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F ClassF
Contractor's Address Contractor's E-mail Address
City State F Zip [_ Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $