HomeMy WebLinkAboutX2022-1482 - Permit ApplicationPrint Form
1 Worksheet for Combo Building &Solar Permit Application CODE
r Comm'I r-- Residential City of Newport Beach - Building Division x o 7-
Residential W8Z NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building r` Grading (-Drainage -Elec FMech J- Plum Cu Yd cutF Cu Yd FillF_
Project Address (Not mailing address) f7 Flood r Fire r Liq r' Landslide rN/A Floor Suite No
Z F F
Description of W rk
Use ConstTypeF_
r m �
r # StoriesF # Units (if Res) _
New/Add SF�— Remodel SF�— Valuation $
Garage/New/Add Material/Labor0 m
OWNER'S NAME Last,
First
Owner's Address
Owner's E-mail Address
1�
City - State -
_. ZIP [_ TelephoneF�
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
City I
- -
State Zip �— Telephoned
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
City
ENGINEER'S NAME Last
Engineer's Address
State �—
First F� Lic. No. F—
Architect/Designer's E-mail Address
ZAP �— Telephone---
First F� Lic No. —
Engineers E-mail Address
City _. _ State F— ZiP [ Telephone
CONTRACTOR'S NAME/COMPANY /� /� Lic. No. �-� _
y/classl%\
Contractor's Addres�siy, Contractor's E-mail Address "K{{JJJ
City State
i �h A T/yt C, - I i r Z1P Telephone % tJTa _ �d %r7l
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO,
PLAN CHECK NO.
PLAN CHECK FEES $