HomeMy WebLinkAboutXR2022-2153 - Permit Application�_ - P(int Form - _a Worksheet for Combo Building & Solar Permit Application
F- Comm'I r)(Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
F-Building F- Grading F-Drainage F-Elec F-Mech F Plum cu YdcutF— Cu Yd Fill F—
Project Address (Not mailing address) F- Flood F- Fire F- Liq F- Landslide FN/A Floor Suite No
128_ V A_CB DoVA, _- - F - F--
Description of Work
Use F— ConstType
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#Stories #Units (if Res)
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New/AddSFF— Remodel SF 99 Garage/New/Add
Valuation
Material/La$ boIts,
OWNER'S NAME Last _FLR 11 i•AN First
Owner's Addressss�
Owner's E-mail Address
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city IIF_-l((T RF�" State Zip TelephoneQqg6�Z
APPLICANT'SNAME Last �`A�I - First -r'G)M
Applicant's Address Applicant's E-mail Address
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City t`k E-�&PT Elio /J State 2 A Zip - Telephone 041 (irZ�Z
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ARCHITECT/DESIGNER'S NAME Last First F—
Lic. No.
Architect/Designees Address Architect/Designees E-mail Address
City State �— Zip �— Telephoned
ENGINEER'S NAME Last First r® Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F Zip I TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City y�i /kj�j(iState ICA;-,-- Zip � TelepmM - r')5Qq
SETBACKS REAR SETBACKS FRONT PERMITNO. Ly • Z) �j 3�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $