HomeMy WebLinkAboutX2022-1175 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (IN
F_Comm F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j—Building FGrading r—Drainage rElec r'-`Mech rplum CuYdCut CuydFill F v
Project Address (Not mailing address) I- Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F_ Const Type
# Stories # Units (if Res
i VCvM Q-L- VAC) ,ram rANLt� 3f�
Valuation $ c<
Material/Labor (� , CDo 0
New/Add SFF Remodel SF�— Garage/New/Add �—
OWNER'S NAME Last s 00 -A U_(^ First
Owner's Address Owner's E-mail Address
City I G �D A,,\, State �— Zip F.-- Telephone
APPLICANT'S NAME Last ��y(�n—� First I --\,�
Applicant's Address Applicant's E-mail Address
City � � � State C / Zip C1 i 6� Telephone q `( al �� � - ��SfS L
ARCHITECT/DESIGNER'S NAME Last _ _ First F Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
!� \�
City State ZIP Telephoned —
ENGINEER'S NAME Last First— Lic. No.F—
Engineers Address Engineer's E-mail Address
City State F— Zip I Telephoned
CONTRACTOR'S NAME/COMPANY,3 f,VX5V�>1 Lic No. � ( � Class T
Contractors Address Contractor's E-mail Address
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City State L� Z i P FT66 3 Telephone F—
SETBACKS REAR SETBACKS FRONT PERMIT NO. t< -o ZZ- 17 S
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Zj()6 , 7_pj Q
USE ZONE DEVELOPMENT NO I"�Z�21 ��i,h PLAN CHECK FEES $