HomeMy WebLinkAboutX2022-0483 - Permit Applicationint Form Worksheet for Combo Building $ Solar Permit Application
omm'I Residential City of Newport Beach - Building Division
X. NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ect Address i
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r- Mech F- Plum Cu Yd Cut I Cu Yd Fill
I- Flood r Fire r Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use � j ConstType V_3
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# Stories[ 2 # Units (if Res)F
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Valuation $
Material/Labor I
New/Add SFRemodel SF Garage/New/Add F —
C1OU
OWNER'S NAME Last Cc,���.t(
First I G( 13 j /A/,4
Owner's Address
Owner's E-mail Address
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City %JV! kjj17 I-30"
State Cia
Zip `�Z(C,(p'Z Telephone `�Z % - SZy7
APPLICANT'S NAME
Last 1lEy
FirsttJl7
Applicant's Address
Applicant's E-mail Address
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Citycl4tl :JA PIk,.)
State (#i
Zip c%2L;.5_3 Telephone 44-71 S%3--165V
ARCHITECT/DESIGNER'S NAME Last f�iI Let/ First jai Ui n Lic. No.I CZ7 t /LLI
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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D2 #ldl
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City I LA6,JA f4it)
State (_/4
Zip C(Z&,T 3 Telephone C,t4
ENGINEER'S NAME
Last I W1 o0j
First KALCU Lic.No. C_P7 ST
Engineer's Address
Engineer's E-mail Address
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QyZ 701
Ln�. Vl:�CIULSC .(6M
City ogk4 ujA 14a j
State CA-
Zip �Sj Telephone '7it4- 574p-6j7q
CONTRACTOR'S NAME/COMPANY
Lic. No. �— ClassF_
Contractor's Address
Contractor's E-mail Address
City
State F__
Zip F Telephoned`
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X W LL - (J
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. Mtir
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $