HomeMy WebLinkAboutX2022-1795 - Permit ApplicationI_ Print Form Comm'1 I Worksheet for Combo Building & Solar Permit Application
F � esidential City of Newport Beach -Building Division
11 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building [_Grading r-Drainage F_Elec rMech F-plumcuYdCut F_ CuvdFill F_
Project Address (Not mailing address) 1- Flood r- Fire r Liq F Landslide F_N/A Floor Suite No
?-, 5 I� �/ l k6v4- 1 I I
Description Work
Use F—ConstTypeF_
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# StoriesF—# Units (if Res)F_
Valuation $ S
Material/Labor `( aUo
New/Add SFF— Remodel SF� — Garage/New/Add F
OWNER'S NAME Last Y"A (�' �� First
Owner's Address Owner's E-mail Address
City F P5 State FWJ Zip F_ TelephoneF—
APPLICANT'S NAME Last - A-0 U S First
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Applicant's Address Applicant's E-mail Address
City M State Zip j I O/G /t Telephone
ARCHITECT/DESIGNER'S NAME Last UN��pq�l�t�va�ht�— Lic.No.�
Architect/Designees Address Architect/Designer's E-mail Address
city State �— Zip �— Telephone�—
ENGINEER'S NAME Last UIviVfP-�At 6Ziow-wirst Lic.No. �--
Engineer's Address Engineer's E-mail Address
City State Zip ! � Telephone
CONTRACTOR'S NAME/COMPANY PJ T t1'5T(,v�10w Lic No. �� Class F
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Contractor's Address Contractor's E-mail Address
2 y2 yZ 22o a. j cbNS 1 6, &7L , Cvr"l
CityF_M7 State — Zip F_ Telephone 57- 3ii7 %j 193
SETBACKS REAR SETBACKS FRONT PERMIT NO. Z�2Z� 1795
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 5 (_LO2 Z
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $