HomeMy WebLinkAboutXR2022-2713 - Permit ApplicationPrint Form NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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VVorksheet for Combo Building &Solar Permit Application71 q
Comm I Residential City of Newport Beach - Building Division
F—Building F_Grading rDrainage j—Elec j—Mech F—PlumCu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) f Flood F_ Fire F_ Liq r Landslide I -N/A Floor Suite No
CA —
Description of Work
Use ConstType F
# Stories # Units (if Res)
New/Add SF� Remodel SFF— Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME LastFirst 4C)
Owner's Address Owner's E-mail Address
_700-32 V_[ I 01 G
G .- /. 4Z
city State ZIP ZJGd Telephone� 3/0
APPLICANT'S NAME Last j `j First C wA,:djC
Applicant's Address Applicant's E-mail Address
City � State �— Zip �— Telephone—
ARCHITECT/DESIGNER'S NAME Last 0 First � L b Lic. No.
Architect Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— Telephone
�—
ENGINEER'S NAME Last 7 First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone F_
CONTRACTOR'S NAMEXOMPANY Lic. No. F— Class
Contractor's Address Contractor's E-mail Address
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City I State F— Zip r--- Telephone[b
SETBACKS REAR SETBACKS FRONT PERMIT N0.
SETBACKS LEFT SETBACKS RIGHTPLAN CHECK N0. -T6��y2��
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $