HomeMy WebLinkAboutXR2022-2678 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application
r— Comm] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL xff - V 1 7 I
7 u aE
F—Building r Grading
F—Drainage F_Elec j—Mech r Plum Cu Yd Cut Cu YdFIR
Project Address (Not mailing address) F_ Flood F_ Fire LLiq r Landslide F_N/A loor Suite No
Ii—
c S
Cam'
Description of Work
Use F—ConstType
# StoriesF_ # Units (if Res)[
Valuation $
Material/Labor
New/Add SFI—
Remodel SFF Garage/New/Add �—
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City State F— Zip F-7 77 Telephone --
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
State �— Zip F Telephone[—
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State �— Zip Telephoner
ENGINEER'S NAME
Last First Lic NoF_
Engineer's Address
Engineer's E-mail Address
State F Zip Telephone�—
CONTRACTOR'S NAME/COMPANY e Lic. No. aggQZ Class C 1D li • �1PC� i 1C O� OCc1Y�
C ractor's Address--- --
Contractor's E-mail Address
V6eklC, Arno l Co M
City 95wU 11�„S State ek Zip qq2 5-3 Telephone r�l,,il _ 3q2_ S-70(,
J
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $