HomeMy WebLinkAboutPC2022-2491 - Permit ApplicationL Print Form J Worksheet for Combo Building & Solar Permit Application
(— Comm'I F_ Residential City of Newport Beach -Building Division%Qg
NOTE: PLAN CHECK FEES DUE AT TIMF OFRI iRnni 6
F—Building F_ Grading I —Drainage j—Elec FMech plum Cu Yd Cut Cu Yd Fill?
Project Address (Not mailing address) 17 Flood F- Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use F_ ConstType
#Stories # Units (if Res)
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New/Add SF— Remodel SF�— Garage/New/Add �—
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Matertion
ial/Labo
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City �( State FLk Zip Telephone
APPLICANT'SNAME Last t fA 1 First
Applicant's Address Applicant's E-mail Address
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City Sh.tJ �� �—s State Zip /a6%s Telephon �`�_� it�`2_4'352�
ARCHITECT/DESIGNER'S NAME Last Q First�� Lic. No. F—
Architect/Designer's Address Architect/Designer's E-mail Address
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City `}�, State �— Zip $ab �9 Telepho 4 y09 9059'Z
ENGINEER'S NAME Last First Lic. No. —
Engineer's Address Engineer's E-mail Address
City State F Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY kttdtiN 9 q 7
Lic. No. Class
Contractor's Address Contractor's E-mail Address
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City State Zip r— — Telephone®
SETBACKS REAR SETBACKS FRONT PERMIT NO. PC 2-02_Z ' Zt i l I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT N PLAN CHECK FEES $