HomeMy WebLinkAboutX2022-1440 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
@xw
.o.
Building Grading r,Drainage XElec r.'�-Mech Plum Cu vd cuts Cu yd Fillr
Project Address (Not mailing address) r Flood r Fire i- Liq r Landslide rN/A Floor Suite No
Description of Work
Use Q� ConstType v$
W1NA--vI'1 IN
W
#Stories #Units (if Res
- 13 II --
New/Add 5F Remodel SFl 1K Garage/New/Add �—
Valuation $ V
Material/Labor t�
OWNER'S NAME Last �y��
_ �First �(IM
Owner's Address
Owner's E-mail Address
City State Zip F Telephone 746, 0"IT
APPLICANT'S NAME Last (/�/�j��J First
v
Applicant's Address Applicant's E-mail Address
City State �— Zip ..°ilby� Telephone 19M, 476 Sill 1
ARCHITECT/DESIGNER'S NAME Last `�'—ze �DI 1 ["T� First �— G11-566
R+l �T^r I Lic No.
Architect/Designer's Address Architect/Designer's E-mail Address
City [— State [_ Zip �— Telephoners
ENGINEER'S NAME Last / bf® First M lc
R,1 .Cr ( Lic No.
C%
Engineer's Address Engineer's E-mail Address
a�3 dr
City rbi;;SA State C� Zip G�/J�� Telephone
CONTRACTOR'S NAME/COMPANY tl / , 5 _ , t� • Lic No. t VI `�, O Class
Contractor's Address Contractor's E-mail Address
City _ State F_ Zip �— Telephone '�cl ��
SETBACKS REAR SETBACKS FRONT PERMIT NO. x202'2'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (32
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $