HomeMy WebLinkAboutXC2022-2130 - Permit ApplicationPrnt Form Worksheet for Combo Building & Solar Permit Application na
City of Newport Beach - Building Division Comm'I [Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑ Grading CDrainage ❑ Elec El Mech [ Plum Cuvd curl l Cu rd Fla I I
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide I /A Floor Suite No
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Description of Work
Use C onstType RI
# StoriesE # Units (if Res)
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valuation 5
Material/Labor
New/Add SF Remodel SF Catage/New/Add
OWNER'S NAME Last _ �', JGs & First
Owners Address Owner's E-mail Address
CRY State G,c� ZP Telephone
APPUCANT'SNAME Last I First
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Applicant's Address - Applicant's E-mail Address
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City (% C(�j _ State C I Zip ZC(i% /; Telephone - 7, �O
ARCHITECT/DESIGNER'S NAME Last > First � � Uc.No.
Architect/Designers Address Architect/Designees E-mail Address
CRy l _!Vqv ~ '7 � i State F—c ! Zip �J Telephone
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ENGINEER'S NAME Last First Lic No.
Engineer's Address Engineer's E-mail Address -
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City j State ! Zi ! Telepho
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CONTRACTOR'S NAME/COMPANY LIC.NO.lCl,!_l�Class}�
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Contractors Address Contractor's E-mail Address
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1City State Telepho
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SETBACKS REAR SETBACKS FRONT PERMIT NO.)( 31— 2130—
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO-
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $