HomeMy WebLinkAboutXR2022-2218 - Permit ApplicationForm Worksheet for Combo Building & Solar Permit Application
F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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Project Address (Not mailing address) F7 Flood
of Work
New/Add SFs—
OWNER'S NAME
Owner's Address
11I4�111 m Cu Yd Cuts Cu Yd Fill
[ Fire r Liq F_ Landslide rN/A Floor
Suite No
Remodel SF l /5 .. Garage/New/Add I —
Last wir First I �
Use Const Type v
# StoriesFT # Units (if Res)
Valuation $
Material/Labor F
Owner's E-mail Address
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City j-
State
ZIP Telephone aj�—
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7APPLICANT'S NAME Last
h/Lrj ✓y.( First �`'
ant's Address
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Applicant's E-mail Address
TA
City — - _
c�Cp yp� State L+ q Zip 92�i9 Telephone
445.4 4�i4
ARCHITECT/DESIGNER'S NAME
Last �.�� First QOI� --_ _ Lic. No ��
Architect/Designer's Address — -
Architect/Designer's E-mail Address
- Kfl /DYI a I orl A2ap'tlz> (2vrkl I &C
City / Q dCO8 -
�115 p/OJ State !� Zip ( Telephone 2 ! 81
ENGINEER'S NAME Last
D9a First F® Lic. N�
Engineer's Address Engineer's E-mail Address
- - - --
City Z7AlvMA.1 Re._,j. State �® Zip Telephone7/
`f'� q25 9'542.
CONTRACTOR'S NAME/COMPANY
Lic. No. yjt`J �/,/ Class
Contractor's Address Contractor's E-mail Address
City
State �— Zip
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Telephone®
PERMIT NO. X.ezoZz • Zzz7
PLAN CHECK NO. .ZC57
PLAN CHECK FEES $