HomeMy WebLinkAboutX2022-1100 - Permit ApplicationPrint Form: Worksheet for Combo Building & Solar Permit Application
r comm"esidential City of Newport Beach - Building Division o q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4 0„
rAilding Grading ( Drainage rElec FMech
F—PlumCu Yd Cuts Cu vd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq r Landslide F_N/A Floor Suite No
Description of Work
Use ConstType s
}�jloGfL QAUL
# Storiess # Units (if Res)s
„
Valuation $
Material/Labor
New/Add SFs— Remodel SF 7— Garage/New/Add l
OWNER'S NAME Last a— It,
First
Owner's Address
Owner's E-mail Address
rr� II
I�i
Q_. u J YS / _ lx _
City \ Q U For j % .h> , State C
Zip Cj 2 b j 7 Telephones
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State
Zip s Telephonel—
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F--
—
Zip s— Telephone
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State �
Zip F_—Telephone �—
CONTRACTOR'S NAME/COMPANY 1� S e �Y
Lic No. S� / 4 Class
Contractor's Address
Contractor's E-mail Address
City State F—
ZipF Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES