HomeMy WebLinkAboutX2022-0066 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F Comm'I j f4esidential City of Newport Beach - Building Division o g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading
F-Drainage F_ Elec F_ Mech r Plum CuvdCutI CuvdFill
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide [_N/A Floor Suite No
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Description of Work
Use ConstType
r
�lu>r�
# Stories #Units (if Res)
am
Valuation $
New/Add SF F
Remodel SF F-- Garage/New/Add F_
Material/Labor
OWNER'S NAME
Last First PSG¢
Owner's Address
Owner's E-mail Address
949 Dp-
City I
State F_ Zip F_ Telephoned
APPLICANT'S NAME
Last � � First jib +,14
Applicant's Address
Applicant's E-mail Address
�JFit'7CI%1,4e-,Corn
City
State Zip F— Telephone
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No. F®
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip TelephoneF—
ENGINEER'S NAME
Last First Lic. No.r
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. I ClassF
Contractor's Address
Contractor's E-mail Address
City
State Zip F_ Telephonel
W !lam
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. &J y!L ^ 00'A,
PLAN CHECK NO. (AMI • 2Q ( b
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PLAN CHECK FEES $ 402-,