HomeMy WebLinkAboutXR2022-2723 - Permit ApplicationL Print Form. I Worksheet for Combo Building & Solar Permit Application °R>
F_ Comm'I F- Residential
City of Newport Beach - Building Division a-
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building j—Grading F-Drainage F-Elec F_Mech F-PlumCu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) F Flood F_ Fire F_ Liq F_Landslide F_N/A Floor Suite No
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Description of Work
Use F—ConstType I
# Stories # Units (if Res)F
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Valuation $ �� L--
Material/Labor ���T6ri )
New/Add SF f Remodel SF Garage/New/Add F
OWNER'S NAME Last�-
r �WOwner's
Owner's Address
E-mail Address
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City �L ksd$�1IQL Stater Zip \ I� Telephone
APPLICANT'S NAME Last �_S_ First NtyJ C ,
Applicant's Address Applicant's E-mail Address
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City 4VQ _QF_7)C. t� State Zlp Telephone l) k,-4-
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ARCHITECT/DESIGNER'S NAME Last , First �— Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
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City State �— Zip �— Telephone
ENGINEER'S NAME Last F® ®First F_ Lic No.F—
Engineer's Address Engineer's E-mail Address
City �c State �® Zip Telephone
CONTRACTOR'S NAMEXOMPANY I C Lic No. 0' Class
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Contractor's Address Contractor's E-mail Address
City ^ State Zip �j r.� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. x (Z'%
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 'i' �'4,` — CC;7? PLAN CHECK FEES $