HomeMy WebLinkAboutX2022-1188 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4 E"�ae
(— Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
KBullding F Grading rDrainage F Elec f Mech
Plum Cu vd Cuts Cu Yd Fill F
Project Address (Not mailing address) r Flood r Fire F Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F_ ConstType
# Stories # Units (if Res)F_
New/Add SF F_Remodel SF S Q Garaa/New/Add
9 F—
Valuation
iaV MaterLabor /
OWNER'S NAME Last {3���
First
Owner's Address
Owner's E-mail Address
CA
City 'Q CaceJ State 0--la
ZipFZ: Telephone9(4Q_a�C_,)j(,C
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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City � � ���t State
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Zip Gj o1 q Telephone 'L�C(
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ARCHITECT/DESIGNER'S NAME Last F Lic. No.
Arch itect/Designers Address
Architect/Designers E-mail Address
City State F_
Zip [_ TelephoneF_
ENGINEER'S NAME Last
First Lic No.
Engineer's Address
Engineer's E-mail Address QQQ
City State F_
Zip I TelephoneF__
CONTRACTOR'S NAME/COMPANYITES D
Lic. No. F-- Classr—
Contractors Address
Contractors E-mail Address
City State F_
Zip F Telephones --
SETBACKS REAR SETBACKS FRONT
PERMIT NO. %C262Z � 1192
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Q Z' Z02 Z.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ `3 t l a _
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