HomeMy WebLinkAboutXR2022-2999 - Permit ApplicationPrint Form_- , Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
j Comm'I ResidPntial NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_Grading Drainage i—Elec Mech F-Plum Cu Yd Cut F cu Yd FillF
Projects Address (Not mailing address F_ Flood F_ Fire f Liq - La ndslide (—N/A Floor Suite No
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Description of Work
Use F_ ConstType
K, t�- 4, r h AMR10
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#Stories #Units (if Res)
Valuation $
Material/Labor 5'
COO (0
New/AddSFF Remodel SF
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Garage/New/Add
OWNER'S NAME Last First c�iYcflC ��artes �jra LLL.
Owner's Address
Owner's E-mail Address
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So�t'l (� 5,he7I Co>ti�
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City nd✓ J�zG..- -
State G <} Zip �L ( Telephone 3�d sj Sr�
APPLICANT'S NAME Last First 5
Applicant's Add//resss/
Applicant's E-mail Address
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G7h LIIL SGNet `L6 vv�
City ✓ V/ECy. State
Zip Telephone Z
ARCHITECT/DESIGNER'S NAME Last First u 5 f Lic. No.
Architect/Designer's Address
Architect/Designers E-mail c�
Address
✓�675fe6lCle51/ 71 L-U�� L071't
City State 1-7
Zip F Telephone
ENGINEER'S NAME Last
First 1 / Lic. No.7—
O n-�(�-i nf�t
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Engineer's Address
Engineer's E-mail Address
2�i3�2_/Vla�(e_✓a / sy7
� c6tz�L c c e c iv+C. �
City VI �' r a State L A
Zip 2- 771 Telephone q ! [-I 6 �. _ G ? q G
CONTRACTOR'S NAME/''COMPANY 0 ww`ev
Lic. No. �— ClassF
Contractor's Address
Contractor's E-mail Address
City �— State F
Zip TelephoneF
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �Cltiv2 Zb f
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $