HomeMy WebLinkAboutXR2022-3191 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application z A
j- Comm'I r Residential City of Newport Beach - Building Division XRICa- 2vhI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G<,
F-Building r Grading F-Drainage VEIec Mech
Plum CuvdCut- CuvdFill
Project Address (Not mailing address) r Flood F Fire j- Liq r Landslide FN/A Floor Suite No
Description of Work
Use F— ConstType
# StoriesF_ # Units (if Res)F_
Valuation $
New/Add SF Remodel SF �— Garage/New/Add �— Material/LaborFS; �`'
OWNER'S NAME Last ��
First
/
Owner's Address
Owner's E-mail Address ---
City C,,,-, lo'd M-1 State /L%
Zip F— TelephoneF—
APPLICANT'S NAME Last to T`I —
First 41,1,1-)
Applicant's Address Zoo .Z S. SAS Ff-
Applicant's E-mail Address
_
City /, Jl ` State �
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Zip Telephone 2�p, J Z /
ARCHITECT/DESIGNER'S NAME Last
First F— Lic. No.
Architect/Designees Address kkL�rc
itect/Designer's E-mail Address
City State F_
Zip F_ TelephoneF_
ENGINEER'S NAME Last
First �— Lic. No.1
Engineer's Address
Engineer's E-mail Address
City I State F_—
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY p %9 Lic.N0. J %� 7y Classy //
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Contractor's Address
Contractor's E-mail Address
City State �—
Zipl 117 j � Telephone -p! -f Z-3 / U vo,
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 4ZO l.E/ r.Z Z S0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $