HomeMy WebLinkAboutXR2022-2721 - Permit ApplicationL Print Fom J Worksheet for Combo Building & Solar Permit Application W�q>
(- Comm I FilCResidential
City of Newport Beach - BuildingDivision ^7
NOTE: PLAN CHECK FEES DUE AT TIME OF St IRMITiAI ;u 96- a
Building F Grading rDrainage Elec j_/Mech I Wlum CuYdCut CuvdFill F
Project Address (Not mailing address) C Flood F Fire F_ Liq [_ Landslide F_N/A Floor Suite No
Description of Work
Use ConstType V$
I- #Units (if Res)
PDX-- Wes,��Stories
Valuation $ OD
Material/Labor
New/Add SF �--- _— Remodel SF 1 4i77 ip Garage/New/Add �--
OWNER'S NAME Last tij� FirstFiv
Owner's Address
Owner's E-mail Address
p�
city� 1 p
pj'6+w'� State I �-T-'- Zip �(� Telephone[
APPLICANT'S NAME Last PFr
First `
Applicant's Address Applicant's E-mail Address
City State �- Zip Telephoner
ARCHITECT/DESIGNER'S NAME Last % First FF Lic. No.
Architect/Designer's Address ArchitectiDesigner's E-mail Address
city �p(�-QQ State ��— Zip ��(p(�� Telephone (ii5179;r06
ENGINEER'S NAME Last Y } ! First 5%)Ci Lic. No e
Engineer's Address Engineer's E-mail Address
�Z�\'l -ern 0 0 5e1�1e . UOA
City �., State I � ' Zip Telephoned
CONTRACTOR'S NAME/COMPANY {9I1� r l� Ai 23 L Class
i I, 2 F� Lic No. I v
Contractor's Address Contractor's E-mail Address
City State Zip Telephone jz
SETBACKS RE SETBACKS FRONT PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $