HomeMy WebLinkAboutX2022-0279 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding (- Grading rDrainage F_ Elec F-Mech F_ Plum CuvdCut CuYdRI F
Project Address (Not mailing address) r Fire F- Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use F ConstType F
# Stories # Units (if Res)
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Valuation $
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New/Add SFF— Remodeldel SF7 Garage/New/Add F—
Material/Labor
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City � � TelephoneF_v
APPLICANT'S NAME Last First I /ef)I-Z��
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
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ENGINEER'S NAME Last First Lic .I
Engineers Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY � `� / ' Lic. No. ��I ss
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Contractors Address Contractors E-marl A re��
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SETBACKS REAR SETBACKS FRONT X�2"�"' PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
_Print Form Worksheet for Combo Building & Solar Permit Application of=E" °gym
F_ Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j-Building F Grading
F-Drainage F, Elec F. Mech F_ Plum Cu vd Cut17 Cu Yd Fill
Project Address (Not mailing address) C' Flood F_ Fire j- Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F—ConstType F_
# StoriesF_ # Units (if Res)
New/
Remodel SF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME
Last First '
Owner's Address
Owner's E-mail Address
Ybi ¢.1 f'CS C�
City
--- Sta e C t4 Zip 7�4� Telephone / ✓.. %L bl �
AP CANT'S NAME
Last First
Applicant ddress
Applicant's E-mail Address
City
State �- Zip F_ Telephone�—
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
- --
Architect/Designees Address
Architect/Designees E-mail Address
City
State F Zip Telephone
ENGINEER'S NAME
Last First Lic. No.F
Engineers Address
Engineer's E-mail Address
City
- State F Zip F Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractors Address
Contractor's E-mail Address
City
State Zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. t t l
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT'NO PLAN CHECK FEES $