HomeMy WebLinkAboutXR2022-2120 - Permit ApplicationL Print Form Worksheet for Combo Building & Solar Permit Application /o///�`� °am
j`'Comm'I ji/Fiesidential City of Newport Beach -Building Division f3
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding Grading F-Drainage [Elec (-Mech F-Plum Cu yd Cut Cu Yd Fill)
Project Address (Not mailing address) F7 Flood r Fire j- Liq r Landslide FN/A Floor Suite No
Description of Work /*2'zSTOIZ-A%10AV
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#Stories #Units (if Res)�7
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Valuation $ � oc
Material/Labor
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New/Add SF� `SF—
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OWNER'S NAME Last O First
Owner's Address Owner§-E=mai1 Address
City i State Zip — TelephoneF------
APPLICANT'S NAME Last �/�r%�. � First
Applicant's Address Applicants E-mailAddress
2D�o �Z A%IJALD�tJF Avg., --------.. _- vA � 0 -7 /. - _ Colyr
City .46 60, SCA/v/> State TA Zip 9z�� 2- Telephone
ARCHITECT/DESIGNER'S NAME Last A// f r First AiU iJ c Lic. N . 02 45-
Architect/Designer's Address Architect/Designer's E-mail Address
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CRY State C—-Zt(Tf7777 Telephone�—
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address
City State �— Zip I TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class F
Contractor's Address Contractor's E-mail Address
City State F Zip I TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO. X ZZ • Za
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 4e? f j27- /9j!5
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $