HomeMy WebLinkAboutX2022-0419 - Permit Application,)(z)vC) AI I
Worksheet for Combo Building & Solar Permit Application
r Comm] ( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
D(Building D(Grading ,Drainage [_Elec rMech F_ Plum CuydCut 1
Project Address (Not mailing address) C Flood r Fire r Liq F_ Landslide
New/Add
OWNER'S NAME
Owner's Address
Cu Yd Fill
F_N/A Floor
Suite No
orJ pj(,�j Use ConstType�
3 E/ by � # Stories # Units (if Res)F
Garage/New/Add
Last I 0i csa ._. First
Owner's E-mail Address
11 5a.4uK _Lave __ _ L_Sad&6Z 9mat I coyo
City JGL),XCL t�t ROLV- _.._ .._ State I l_%" Zip.. �/,2.(PaS_.: Telephone Zlyl , l-a.y(7
APPLICANT'S NAME Last
Applicant's Address
City JCc OwC�_ k` py- State
First
Applicant's E-mail Address
r1Or�V1
I + Zip � �J Telephone �( L( � Al 7
ARCHITECT/DESIGNER'S NAME Last 1�'�� First 1 ` tto� Lic. No. j
Architect/Designer's Address Architect/Designer's E-mail Address
hrqZ�nW� x C ��ryt[�✓11ut , jtlqplLC l��yik�7Ft .CO WI
City V\�0. �0.vlL State C Zip �G'( Telephone�I7 q m
ENGINEER'S NAME Last kxYX First N.Ev1G) '.. `}; S°]�%P7
Engineer's Address
� n 1. , J Engineer's E-mail Address
(//
90 -mac tm& 000-f,1aCl� city.[�C�\ State C� Zip 2((��� Telephone t�
CONTRACTOR'S NAME/COMPANY ^ Lic. No. F -- Class
Contractor's Address Y Contractor's E-mail Address
City State �� Zip Telephone I
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. t�
PLAN CHECK NO. Q / 0
PLAN CHECK FEES $