HomeMy WebLinkAboutXR2022-2037 - Permit Application"fit Form _ Worksheet for Combo Building & Solar Permit Application DIRRIP
Comm'I Rsese idential City of Newport Beach -Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALF
Grading j`Drainage V_S ec r Mech T p
j�yPlUm Cu Yd Cut Cu Yd Fill
ss (Not mailing address) F Flood r Fire �Liq j- Landslide I -N/A Floor Suite No
z$7"fi rLCrYLFjecrption of Work
11EPLACzUv �-�, F Use ConstType
ore 7zc+ �
CA8 ,vc 7 #Stories[ #Units ± ---�- 75--_�tc--.mil-'(if Res)
New/Add SF Remodel SF # Valuation 5 _ (qUO Garage/New/Add �—
Material/Labor] 2 O (yc7C�
OWNER'S NAME
Last P1q T
__.._ _ _ First /-I/I'XtJ�-L L Owner's Address
Owner's E-mail Address
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aty lit_u�t�rc _ - -- C?Azc co'l - A p --
State - - c79cN_,_ - - _
Zip LZL (ov - Telephone
APPLICANT'S NAME 0 ZYo _t(2A_7
Last ��c ,3u�zC
- --- - First M�lxwr c
Applicant's Address __---__
SAS A
Applicant's E-mail Address
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City C�.�tr1rC.Co"-1
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State _ _-_...-----
4 Zip Y ZG fflo Telephone--
- - - ARCHITECT/DESIGNER'S NAME
Last First F
Architect/Designer's Address Lic No.
Architecf/Designer's E-mail Address
City
State �Zip
— Telephone
-_--_- - ----. __
ENGINEER'S NAME
Last
First --7777 Lic. Nof�
Engineer's Address
Engineer's E-mail Address
City
State --_
- - Zip Telephone —
CONTRACTOR'S NAME/COMPANY
Lic No. �— Class
Contractor's Address -
Contractor's E-mail Address
City - State �— Zip -
TelephoneF
LSEA
REAR SETBACKS FRONT
LEFT _ SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. X��Z?i - Zc37
PLAN CHECK NO.f CTIJZZ,, 476�?
PLAN CHECK FEES $ 1 " ?3