HomeMy WebLinkAboutX2022-1473 - Permit Application' Print Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECIK FEES DUE AT TIME OF SUBMITTAI
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Building r Grading F-Drainage 'h[tlecF plum Cu vd CutF Cu vd Fill F
Project(Not mailing address) ice- H000 r Fire F—LLo F_ Landslide rN/A Floor Suite No
Address
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Description of Work
Use Const Type
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# Stories[ # Units (if Res)F
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Valuation $
Material/Lahor 20J0C d G
New/Add SF�-- Remodel SFF--- Garage/New/Add �—
OWNER'S NAME Last ��— First F in�C�
Owner's Address Owner's E-mail Address
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City �YJ,� State —C(i� Zip j�— Telephone 9?'? 2_�0
APPLICANT'S NAME Last r1 Q First
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Oct-,-,"
Last 1�.�n Vi(First yl � LicNo.�—
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Architect/Designer's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last First Lic. No. _
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Engineer's Address
9 Engineer's E-mail Address
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City F State �— Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY,6 S f I Lic No. Z36Class�y
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. L'
SETBACKS LEFT SETBACKS RIGHT.PLAN CHECK NO. _ �J • -
USE ZONE DEVELOPMENT NIP'i� PLAN CHECK FEES $ C