HomeMy WebLinkAboutX2022-0971 - Permit Applicationp,�
Print Form Worksheet for Combo Building & Solar Permit Application EWP
r Comm'I r Residential City of Newport Beach - Building Division e
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL SuFo„r
F_ Building F_ Grading [-Drainage j-Elec f-Mech F- Plum cuydcut[— cuYdFlll F_
Project Address (Not mailing address) r Flood [- Fire r Liq (- Landslide [N/A Floor Suite No
1k�p01 �vy CL-7) C�SZ
Description of Work
Use ConstType �—
Stories # Units (if Res)l
Valuation$
Material/Labor
New/Add SFr__ Remodel SFF— Garage/New/Add—
OWNER'S NAME Last F First
Owner's Address t C NCB Ok- rorvi U Owners E-mail Address
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City--.�-_!ei , �,tt State I� Zip ���`j Telephonerc�l{zt-
APPLICANT'S NAME Last. C u jO,S _ First
Applicant's Address Applicant's E-mail Address
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City ._-.[� State Zip TelephoneF) ly Kcs- `4`[�J -
ARCHITECT/DESIGNER'S NAME
First Lic No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City C C�dY State C� Zip �� Telephone -�n,a)
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ENGINEER'S NAME Last First . Lic No.
Engineers Address Engineers E-mail Ad s
City State �— Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic No. �� YClassl \2
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Contractors AddressContractor's E-mail Address
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City -.. �� F [ State c;Q Zip c j Telephone 9L.'
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SETBACKS REAR SETBACKS FRONT PERMIT NO. ��?ZZ
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO D l/I l,7 _ b 16 PLAN CHECK FEES $