HomeMy WebLinkAboutXR2022-2008 - Permit ApplicationPrint Form
_ Worksheet for Combo Building &Solar Permit Application
F_ Comm'I . Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFS ni IF AT TinAF nG ci IMRAI rAl /.
f—Building F_ Grading F-Drainage [ Elec F_ Mech r— Plum Cu vd Cut F_
Cu Yd Fill F_
Project Address (Not mailing address) 1- Flood I- Fire F_Liq F- `Landslide F_N/A Floor Suite No
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Description of Work
Use ConstType
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# StoriesF # Units (if Res)
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New/Add SF�— Remodel SF� Valuation $
Garage/New/Add Material/Labor
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OWNER'S NAME Last
F i First �!L}L E 1-4
Owner''s Address Owner's E-mail Address
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City L'�bv� +T C�wSr State G1i Zip/ TelephoneAy`t3�b`� l�
APPLICANT'S NAME Last FFCvT (�l First l{�L-�
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Applicant's Address
Applicant's E-mail Address
City-�etq3r
t C State
---- zip F Telephone-
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ARCHITECT/DESIGNER'S NAME Last
K First F_ Lic. No. I
Architect/Designees Address Architect/Designer's E-mail Address
City F7777-7---77777State F— Zip F_Telephone
ENGINEER'S NAME Last � : �tv l First ( t� Vi r- iYl2
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- _ � 1 � 'b t�) Lic. No y;� 3 Engineers Address Address Engineer's E-mail Address
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City (r „ State C \ Zip t1 xr!) [� Telephone
CONTRACTOR'S NAME/COMPANY {' 1 _A Lic. . / ' "
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Contractors Address Contractor's E-mail Address
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City nAe ZrYI ) State ZIP� Telephone qq
SETBACKS REAR SETBACKS FRONT
PERMITNO.
PLAN CHECK NO. PCZO-U —tic( 1
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $