HomeMy WebLinkAboutXR2022-2738 - Permit Application_ _P_dntForm Worksheet for Combo Building & Solar Permit Application QOWAX2
City of Newport Beach - BuildingDivision
r Comm'I ( Residential NOTE: PLAN CHECK FEES nt IF AT TlnnOF m IRRA rni
F-Building [Grading f-Drainage r-Elec F_Mech F-plumCu Yd Cut r Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire f Liq r Landslide [_N/A Floor Suite No
F r --
Description of Work
Use Const Type
# StoriesF # Units (if Res)F_
New/Add SF - L Remodel SF�— Garage/New/Add Z
Valuation $
Material/Labor F,/
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OWNER'SNAME Last First
Owners Address
Owner's E-mail Address
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City State C
- - - Zip Telephone �3
APPLICANT'S NAME Laste -- First
Applicant's Address Applicant's E-mail Address
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City State — —.
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ARCHITECT/DESIGNER'S NAME Last ( First, l�n Lic. No. �—
1,
Architect/Designer's Address Architect/Designers E-mail Address
City State F EA Zip qZ& N1, TelephoneWq 41
ENGINEER'S NAME Last First jfA✓kuL Lic.No.
Engineers Address Engineers E-mail Address
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city � State GI �1— Zip s— Telephoner)Ft(63�_ 4;
CONTRACTOR'S NAME/COMPANY �c\i2��jyr FlUSClasW��.c.o.F
Contractors Address Contractors E-mail Address
City -NfWgL,4�- "e"" State CIS Zip 'qj0 Telephone l ff31 �(e
SETBACKS REAR SETBACKS FRONT PERMIT NO. i7lJZ2—Z-7 30
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1 2oZ2� 2 S 7q
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $