HomeMy WebLinkAboutPC2022-2157 - Permit ApplicationPrint Form Worksheet fqj Combo Building & Solar Permit Application °q>
I—Comm'I Retj t2iaf'L 2 —2 City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DI IF AT TIME nF si iannrrrAi
Building (—Grading rDrainage j—Elec r Mech r plum Cu Yd c.tF Cu Yd Fill
Project A(ddres (No mailing address) C Flood r- Fire r- Liq r Landslide [N/A Floor Suite No
Description of Work
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Use I ' ` Const Type I u '/�
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Ain
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# Stories # Units (if Res)
L1
( Z..6
New/Add SFF— Remodel SF�— Garage/New/Add �—
Valuation I
Material/Labor
OWNER'S NAME Last i �K First
Owner's Address
Owner's E-mail Address
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city cS"�r k rA State F Zip '3F Telephone � lc�.
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APPLICANT'S NAME Last �r, ' First J15o
Applicant's Address Applicant's E-mail Address
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City cc Off'
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J H _ State �— Zip
ARCHITECT/DESIGNER'S NAME Last First— Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
city State �— Zip �— Telephone-F
ENGINEER'S NAME Last First F_ Lic. No. F—
Engineer's Address Engineer's E-mail Address
City State �— Zip F— Telephone�—
CONTRACTOR'S NAME/COMPANY , p /� 1 n Lic. No.R�}Q j LClass�
Yl v' 2 I
IE-mail
Contractor's Address Contractors Address
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city ) w State C Zip O/ Telephone { I �/I 10�(�
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO �" —� Z-LAN CHECK FEES $