HomeMy WebLinkAboutX2022-1774 - Permit Application", rm ' Worksheet for Combo Building & Solar Permit Application Qww
wComm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OFSUBMITTAL
Building. Cl Grading [Drainage ,[JElec OMech Plum CuvdCut�l
- _ ! Cu Yd pill
Project Address (Not.mailing address) ❑ Flood ❑ Fire CI Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
L fi Use ConstType �I
N r # Stories # Units (if Res)CI
New/Add SF J Remodel SF Valuation $
Garage/New/Add F Material/Labor
OWNER'S NAME Last
First
Owner's Address -
Owner's E-mail Address
City �- !i State
ZIP TelepF one
APPLICANT'S NAME Last t �^O
li� First -
Applicant's Address
Applicant's E-mail Address
;
city " State �����.—��
` —' ZiP ���D3 Telephone�—
ARCHITECT/DESIGNER'S NAME Last
-- i First — Lic. No. —1
ArchitectlDesigners Address Architect/Designees E_-mail Address
City State C Zip C � Telephone
ENGINEER'S NAME Last
First Lic.No.
Engineer's Address Engineer's E-mail Address
City State I Zip Telephoned-1
CONTRACTOR'S NAME/COMPANY .
--- — /L!,."Class
Contractor's Address tractor's E- ai ddre
City — State C ZiP Telephone_ %
T
SETBACKS REAR SETBACKS FRONT ' PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT IF
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN OHECK FEES $