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HomeMy WebLinkAboutXR2022-2999 - Permit ApplicationPrint Form_- , Worksheet for Combo Building & Solar Permit Application _ 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 _- (-_ z_ __-2__-_-- Description of Work Use F_ ConstType K, t�- 4, r h AMR10 Ole--/ #Stories #Units (if Res) Valuation $ Material/Labor 5' COO (0 New/AddSFF Remodel SF - Garage/New/Add OWNER'S NAME Last First c�iYcflC ��artes �jra LLL. Owner's Address Owner's E-mail Address .._-____....__ So�t'l (� 5,he7I Co>ti� _ 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 / 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 _. _- 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 $