HomeMy WebLinkAboutX2022-1196 - Permit Application- Print Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding 1— Grading F Drainage r Elec r Mech r Plum CuydCut F CuvdFill F
Project Address (Not mailing address) F Flood r" Fire r Liq r Landslide rN/A Floor Suite No
6�3 lc'Is C,0,P4-7 C�q 'F F—
Description of Work I
se Const Type F_
r 2A/N/�C (- L ,s
# StoriesF # Units (if Res)
FQ e3,til V
Valuation $ �, ^..'..rt V V
Material/Labor ljl,Vl V
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New/Add SF�— Remodel SF Garage/N w/Add �—
OWNER'S NAME Last Y U U SS L. /C First d
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Owner's Address Owners E-mail Address `'
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City C._ /Cl l' I LL b State C3 C'_ ZIP _ y Sao Telephone 3 G — 3 ZC
APPLICANT'S NAME Last mw "52 2 First I /l//j if / L_
Applicant's Address Applicant's E-mail Address
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13 e'z Null/iv�_ Y Cif /cIAa/� e���rU/L, 70—C,Cc
City (n/.; 1'% �% //✓ %i. Ca2_ State C,, Zip
;� 2G y� S Telephone � c{i! i /—�O 7.
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
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City O �) State �— Zip / 2S Telephone �� _G 1 Z L 7
ENGINEER'S NAME Last First F— Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F Zip F_ Telephoned —
CONTRACTOR'S NAME/COMPANY ryly/L0, a f `�p/�{yNo, / off? s-7 Z Class !� _� -C_
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Contractor's Address Contractor's E-mail Address
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City VVj/�-- State Zip �`26F 7 Telephone 7/�/_ C;�/—y�j
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X7�iZZ—I Iq G
SETBACKS LEFT 3 SETBACKS RIGHT 3 PLAN CHECK NO. ,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ _ 1 t