HomeMy WebLinkAboutX2022-1537 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(-Building F_ Grading rDrainage F- Elec F- Mech - Plum Cu Yd Cut, Cu Vd Fill r—
Project Address (Not mailing address) 7 Flood F— Fire I-- Liq Landslide N/A Floor Suite No
SOO Cap -
1
Descrripttion of Work
Use F7-- ConstType �
# Storiesa # Units (if Res)
Valuation $
Material/Laborl - i,
'
New/Add SFF Remodel SF I'
Garage/New/Add
OWNER'S NAME Last i i_tiJjCL i (�(Z x� First
Owner's Address [4 D R
Owner's E-mail Address
City State !G�
Zip 1 I'61Telephone;, f q
APPLICANTS NAME Last SSA iri
First CARf.�US
Applicant's Addrenss�
Applicants E-mail Address
23 4`J.
i
(�..5
Criy .. �( State vl.t
c�1�G(77}G
Zip � YJ-~i D� Telephone, -7r T �39 t• J I ..
ARCHITECT/DESIGNER'S NAME Last i
First r Lic No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip TelephoneF—
ENGINEER'S NAME Last I X i
First' i ��� Lic. No.
Engineer's Address
Engineer's E-mail Address
City ISi-,N7 (�l, ti)iN pl,_ State i C
Zip !,i91-7DS Telephone!' ((4 L)SI O
CONTRACTOR'SNAME/COMPANY 1 NCrI�S ( )M ; r+ CDC/ji Lic. No. b3 Classi�
Contractor's Address
Contractor's E-mail Address
City S � N-CC4 �� State �� /�
T
Zip j 1�7�� Telephone
/r
SETBACKS REAR SETBACKS FRONT
- PERMIT NO. )�N
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO _ PLAN CHECK FEES $