HomeMy WebLinkAboutX2022-1820 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
7 Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building F_ Grading F-Drainage F_ Efec r- Mech rPlum Cu Yd Cuts Cu Yd Fill F
Project Address (Not mailing address) F Flood r Fire F7 Liq F_ Landslide FN/A Floor Suite No
Description of Work 3611 H
Use F — ConstType—
# Units (if Res)
# StorIesF7 F
A7r C_� VA J 0-1,61' 1 C,
New/Add SFr Remodel SFF Garage/New/AddF
Valuation $ 56,0040
Material/Labor
OWNER'S NAMELast First
Owner's Address Owner's E-mail Address
City Sia a
'T - 6, —,KTelephone
I Tt Zip F
APPLICANT'S NAME Last Sqv e First
Applicant's Address Applicant's E-mail Address
— ---- ------
City State Zip Telephones--
ARCHITECT/DESIGNER'S NAME Lar First Fi�� Lic. No.
Architect/Designers Address Architect/Designees E-mail Address
City State F_ zip F Telephones —
�ENGINEER'S NAME Last First_jF; < 7r\&Iz�N� Lic.Noj�'C
C
Engineers Address Engineer's E-mail Address
city State F ZiPF Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class F
Contractors Address Contractor'sE-mail Address
City State zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $