HomeMy WebLinkAboutXR2022-2495 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application GO
I- Comm'I F_ Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building [_Grading F-Drainage [Elec F_Meth f-Plum CuvdCut F_ curdFill
Project Address (Not mailing address) F7 Flood r1/Fire r Liq r Landslide F_N/A Floor Suite No
Description of Work Use I— Const Type
IldMA 'CIAMirnl
Stories[— # Units (if Res)F—
a 0 002CG W�i� pirf gran oL --- �°s✓� / �d _ -_- - -
New/Add SF� Val $
Remodel SF Garage/New/Add uation Material/Labor GoQ
OWNER'S NAME Last /��Sd� First TAi9/r
Owner's Address
3D �� Owner's E-mail Address
City 12a.ILV_ %�CC tl� — - State `�l- - ZIP C 9i Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicants E-mail Address
0-7 ( (tAFffSurf P
City - -' ---- - - ,
State — -
Zip f 2k7— Telephone 21F'�8�/r1�
ARCHITECT/DESIGNER'S NAME Last First
777 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
-. _ _-...__--__- -
City State F Zip F_ _ - Telephone�—
ENGINEER'S NAME Last First � Lic. No.�—
Engineers Address Engineer's E-mail Address
City State Zip F Telephoner—
CONTRACTOR'S NAME/COMPANY Lic. No. n9 8 Class
Contractor's Address Contractor's E-mail Address
1671 _hirw 54 * P-
City l4NG{tr 4 State ('/l7_ Zip FjRT-7-- Telephon �1Y 19 (51�4
-r3c�o 7so �3 �6) 23
SETBACKS REAR SETBACKS FRONT PERMIT NO. %C 2 z,Z - C- / C
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, �CZcsyz ZgLf
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $