HomeMy WebLinkAboutXR2022-2380 - Permit ApplicationPrint Form ) Worksfteet for Combo Building & Solar Permit Application
j— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SURMITTAI
rBuilding (—Grading F—Drainage j—Elec F_Mech F—plum Cu Yd CutF_ Cu Yd FlllF_
Project Address (Not mailing address) l- Flood f Fire (— Liq r Landslide f N/A Floor Suite No
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Description of Work
Use Const Type
V L'sL'ciU� t� iJ X LS�iYl �
# Stories # Units (if Res)T
Valuation $
Material/Labor F7u C�`_
New/AddSF� Remodel SF
Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
-`ABC, V-J�L..5t&
City 1 ` �k t 1 � State C�� Zip Telephone— --
APPLICANT'S NAME Last 11? 2.7�Ci t First
Applicant's Address
Applicant's Address
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�E-mail
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City �Zip6ZEG
Telephone CG�1?Jg1 j
ARCHITECT/DESIGNER'S NAME Last �First ft l Lic. No. �
Architect/Designer's Address
Architect/Designer's E-mail Address
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City 1n 12) State (4\
Zip I OrL_b 6 2 Telephone FL46A 4 i a.
ENGINEER'S NAME Last
First F Lic No. F_
Engineers Address
Engineer's E-mail Address
City State F®
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic No. F Class
Contractor's Address
Contractor's E-mail Address
City State �—
I
Zip Telephoned—�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 12 • !//�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Pr _ 2ri
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USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $