HomeMy WebLinkAboutX2022-0787 - Permit Application__Pnnt Form _ Worksheet for Combo Building _ilding &Solar Permit Application(69-1
F_ Comm'I F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
oa+
r-Building F_ Grading F-Drainage f-Elec F_Mech F- Plum Cu Yd cutF_ Cu Yd Fill F_
Project Address (Not mailing address) [- Flood r Fire F_ Liq r Landslide FN/A Floor Suite No
Description of Work
Use Const Type F
�1odc
�,�<<
c`hi�H x Zvi ��� C3�)>rl,
# Stories[— # Units (if Res)F—
New/Add SF F— Remodel SF �— Garage/New/Add �-
Valuation $
Material/Labor
OWNER'SNAME Last First
Owner's Address
Owner's E-mail Address
City State F- Zip I— TelephoneF—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
- - - -
City State F_ Zip — Telephone
ARCHITECT/DESIGNER'S NAME Last First— Lic. No. F_
ArchitectiDesigner's Address Architect/Designees E-mail Address
_ -
City State F_Zip 17 Telephoner
ENGINEER'S NAME Last F�First F Lic. No. F—
Engineer's Address Engineer's E-mail Address
City State F__ Zip Telephoner
CONTRACTOR'S NAME/COMPANY 11 jrl G e j�� fSO��-e ��C Lic. No. �USRC,t,��, (Class L27
L a
Contractor's Address Contractor's E-mail Address ,T 0 74 y
City State F Zip I Telephoned
SETBACKS REAR SETBACKS FRONT PERMITNO. x,ZOZZ'U78 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. U 707_Z0 ZZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $