HomeMy WebLinkAboutX2022-0463 - Permit Application__ Print Form EWE
_:_� Worksheet for Combo Buil-ding "&Solar Permit Application �? a�
Comm'I Residential City of Newport Beach - BuildingDivision F
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
F-Building r Grading F-Drainage F_ Elec F Mech F- Plum Cu YdCut F_ Cuvd Fill F_
Project Address (Not mailing address) F Flood F_ Fire F_ Liq ( Landslide CN/A Floor Suite No
l l0 �cv f?o *a Ci n 27__2 D2. A)bty t9'&,eT /5F j �-F, C 1� . _926(�, o F I I
Description of Work
Use ConstT e
[2 2 vp 3�
# Stories # Units (if Res)F
Valuation $ s_ eo 0•-
Material/Labor tea,
New/AddSFF RemodelSFF— Garage/New/Add
OWNER'S NAME Last M �µj /t4A.&) (,Wl LLLFirst
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Owner's Address Owner's E-mail Address
/40 /V
City 6l)�ca 411—T Z g4 CH State
Zip F772 ,o TelephoneAPPLICANT'SNAME
Last l sI_Fy,k,v First 45-1
Applicant's Address Applicant's E-mail Address
14M S_ Qtc_DR-.
City State —
Zip �— Telephone
ARCHITECT/DESIGNER'S NAME Last / First
IN/^llE Lic. No. Zz 03 Z
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Architect/Designer's Address Architect/Designer's E-mail Address
City �t � -.- ----
Lcs� H�ta$LEf State Zip 1 Z, g- Telephone E/U 2>e-2100
ENGINEER'S NAME Last �j]
t7//�'S_ First Z'L/.C/r'7 Lic.No.t✓FjV=
Engineer's Address Engineer's E-mail Address
- -- - -
City State �! Zip � Telephone[——
CONTRACTOR'S NAME/COMPANY r , N / J�7,�Lic. No. 3a6 lass
Contractor's Address Contractor's E-mail Address
WM
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City 61&- c 6_ State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. . ZgV2
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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