HomeMy WebLinkAboutXR2022-2222 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EW�ga
F- comm-1 Residential City of Newport Beach - Building Division N'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_Grading(-Drainage F-Elec F-Mech F`plum CuvdCut l --� CuYdFill P9
Project Address (Not mailing address) F_ Flood F- Fire F- Liq F- Landslide FN/A Floor Suite No
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Description of Work Use nstT e
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# StoriesF-2—# Units (if Res)F
Valuation $.�
New/Add SF `T I Remodel SF�— Garage/New/Add Material/Labor %(�
OWNER'S NAME Last
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Owner's Address Owner's E-mail Address
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City N�WPdaL� �� State l ZIP 9? % TelephoneF
APPLICANT'S NAME Last First 12-9-Ij'
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last L
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Architect/Designer's Address Architect/Designer's E-mail Address
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city State F Zip F_____— Telephone
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ENGINEER'S NAME Last G Pc$,/ ep_k1P+� — First �j�v : P Lic. No.
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Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY Lic. No. 'D f,3 ZCr1t`i hass�
Contractor's Address Contractor's E-mail Address
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City [,ls�p yvAI12 54 State zip Z-7 Telephone q I L{- a
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK No.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $