HomeMy WebLinkAboutX2022-1777 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application (N-0-A
City of Newport Beach - Buildin Division
Comm'I �Residenrial NOTE: PLAN CHECK FEES DUE AT TIME OF SLIRMITTAI
F-Building F_ Grading 7Drainage Py Elec F_Mech F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) [- Flood [- Fire F_ Liq r Landslide F_N/A Floor Suite No
Descritioonn of Work
Use tdC � Const Type F_
# StoriesF& # Units (if Res)F
Valuat i$ -
Materia1l or Z't6'
New/Add SF�— Remodel SF�- Garage/New/Add —
OWNER'S NAME Last fA0a At-TL(First J(� L(/WA-9-p
Owner's Address Owner's E-mail Address
Al
City1. Mk)Vfook- A U�}- State ZiPFJj6 Telephone �� 63
APPLICANT'S NAME Last S y�t (� First
Applicant's Address Applicant's E-mail Address
City State Zip F— Telephone—
ARCHITECT/DESIGNER'S NAME Last / First Lic. No. F—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F— Telephoner
ENGINEER'S NAME Last �/vhQQ �Q/I SAAWF LicNo.F—
Engineer's Address GJ (/7 Zq /Cagineer's E-mail Address
City State F_ Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY �, Lic. No. 6
1 r i'(� 9" Class F(-- 77
Contractor's Address T Contractor's E-mail Address
City State F— Zip I TelephoneF�
SETBACKS REAR SETBACKS FRONT PERMIT NO. X2C227_���s/
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. %�p Js 2d�iZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $