HomeMy WebLinkAboutXR2022-1846 - Permit ApplicationL Print Form Worksheet for Combo Building & Solar Permit Application o�EWPoR>
Comm'I F Residential City of Newport Beach - Building Division �(� 1R/1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL D
F—Building [ Grading rDrainage F_Elec j—Mech r Plum CuvdCut F CuYdFill F ow
Project Address (Not mailing address) [ Flood r Fire F_ Liq r Landslide F_N/A Floor Suite No
i �.,1 �� t�(;r 4�»Jc e DeF I
Description of Work
Uses Const Type
# Stories # Units (if Res)s
Valuation $
Material/Labor
New/AddSFF Remodel SFS Garage/New/Adds—
OWNER'S NAME First
Lastr..l'�t,c.r(Ci_,.�`
Owner's Address ) Owner's E-mail Address
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City C ! in State— Zip 7Z(s'LS Telephone T� .—
APPLICANT'S NAME Last h First —
.Ili I Cf1C_i `�c?" t _ __..
Applicant's Address Applicant's E-mail Address
City LJ 1, �t State L Zip `")Tb T7 Telephone cis/ C/
ARCHITECT/DESIGNER'S NAME L.ZIi`
Last 7 e L First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
l'
City State �— Zip F_ Telephone[ —
ENGINEER'S NAME Last First Lic. No.F --
Engineer's Address Engineer's E-mail Address
City F State F__ Zip F Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
Contractor's Address Contractor's E-mail Address
City State 7— Zip �— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $