HomeMy WebLinkAboutX2022-0289 - Permit Applicationj Print Form j
F Comm'I I
Worksheet for Combo Building & Solar Permit Application
tial City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ildirfg [ Grading r-Drainage r�c r-PAech Fgym Cuvdcutl (// j�
I Cu Yd Fill
Project Address (Not mailing address) C Flood r Fire F7 Liq r Landslide f N/A Floor Suite No
STr,--Eii/w'orzTA �--
Description of Work 1 t� � k A
-/ %%TGfJN ��f :ST �Gc7J� Use Const Type
# Stories # Units (if Res)F
Valuation $ " [�,c
New/Add SF j/ 2 i o Remodel SIF ( Garag ew/Ad j.1,6 Material/Labor � ,Jq gj Z J �
OWNER'S NAME Last GJ,Ai
U First
Owner's Address Owner's E-mail Address
Crty //E7v'/0G'/2* )04 State �— Zip F/Z&�Zy elephone %14 Z 7 Z
J ,G APPLICANT'S NAME Last First /qP-T
Applicant's Address
Applicant's E-mail Address
TH 5T E:4-Ac1�511�5
City (/W%�� - State I Zip Telephone 27 2 f 6 2�F
ARCHITECT ESIGNER'S ME Last �� �
- / % First V 'ram J Lic. No. ' T
Archit Designer' Address Architect/Designer's E-mail Address
- - r�0s
City State F7,1 .. ZIP Zo Telephone -71+ Z7 2- 1-ter
ENGINEER'S NAME Last First i /
- �r�.�Ni�- Lic. No. 2i.� zsj'
Engineer's Address Engineer's E-mail Address
City j 02V /r/C State Zip 26 G 2-Telephone 7)T Z 7 Z
C)ONTRACTOR'S NAME/COMPANY il/ /J�5 Lic. No. S� p7Class
ontractor's Address .4 `(/ P74ee'Contractor's E-mail Address
A/o �aGl� JI'tez r. g r
ty 7`j s 4(-f p <11 / State C� Zip 1 -�2 Telephone
SE I BACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. GL�,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 0 j ,0