HomeMy WebLinkAboutX2022-1714 - Permit ApplicationPrint Form_) Worksheet for Combo Building & Solar Permit Application @5(
WPC
[, Comm'I [Residential City of Newport Beach - Building Division l�NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building [Grading [Drainage [; Elec [Meth [Plum cu Ydcutl I Cu Yd FillF
Project Address (Not mailing address) [ Flood ❑ Fire [ Liq ❑ Landslide IJN/A Floor Suite No
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Description of Work
Use F ConstTypePAP
#Stories # Units (if Res)F—
imj
Valuation $
Material/Labor Z S / r'VL
New/Add SFF Remodel SF Garage/New/Add
OWNER'S NAME Last l e First I/1n
Owner's Address Owner's E-mail Address
City . ec" a C v>^ o rt State P T� 2 s p � z -S6 1
� � Zi Tele hone O Z.
APPLICANT'S NAME Last �(�{T-VA0u1c (�j First P'R( A
Address Applicant's E-mail Address
/Applicant's
ckc, V" ,Cn i n c 0 C. C
City V v w State ( } Zip Q O7 b Telephone Srvl -(U k 3I 3�j
ARCHITECT/DESIGNER'S NAME Last 1z N f f First I �-
�", �' t ('iCl I Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
11 t ro 1 tsi o �7_40-RZ0,:, T. '(0—
City w�C� w . „ State 7 Zip RT (� 1 Telephone 1 / p - 7 c) - 43 c t 3-
ENGINEER'S NAME Last First FT t Lic. No. L Z c ( z-
Engineer's Address Engineer's E-mail Address
Ili N.jGvioll>~xcY c�. hnnle(�PKS�. C�,
p—
city �P (� State e� \ Zip Q 2 1;il Telephone ( 3 -Tz �'-- � }- s J
CONTRACTOR'S NAME/COMPANY . h� t Lic. No. F677Class 13 -
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Contractor's Address Contractor's E-mail Address
q,662 5Py'1okvw_ i )t dc; f�lc5n 14 C.0 C, cam^
City 1D0wwt State Cn Zip c(dZ L0 Telephone SGZ-000 3/ JS —
SETBACKS REAR 32SETBACKS FRONT Co r-- O PERMIT NO. {jyl✓ i 0
SETBACKS LEFT 4 t ' 6 SETBACKS RIGHT bt-r� PLAN CHECK NO. �( A
USE ZONE �; �[a f7 z I DEVELOPMENT NO PLAN CHECK FEES $