HomeMy WebLinkAboutXC2022-1986 - Permit ApplicationPrntFotm Worksheet for Combo Building & Solar Permit Application @Ts-
U
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ruilding F Grading F-Drainage F_ Elec F Mech F- Plum Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) 1- Flood j- Fire - Liq F- Landslide FN/A Floor
Suite No
Description of Work `
a ' Use Const Type
` b O
n # Stories # Units (if Resf
New/Add SFF_ Remodel SF Valuation $
3�r Garage/New/Add F Material/Labor
OWNER'S NAME Last
_ First
Owners Address
Owner's E-mail Address
City State F-
- — - Zip F_ Telephones--
APPLICANT'S NAME Last
�l6 uf�fA o First _ . 1
Applicant's Address Applicant's E-mail Address
oC b _ S r
II - J-�-J - 5 --�y�al•_ cow
City �i / State / (�
2t�t ZIP i (`F Telephoned
ARCHITECT/DESIGNER'S NAME Last /� 5
�r^� First Architect/DesignersIF Lic. No. Address T ArchitectIDesigner's E-mail Address
City State Zip ------- Telephone
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
;iry
State
First I - - Lic Nos —
Engineer's E-mail Address
zip F—
Telephone�—
State F Zip
Lic. No. s-- Class
Qs
Contractor's E-mail Address q V UsS(i
Telephone
- - r
BACKS REAR SETBACKS FRONT PERMIT NO. iG(a E7
ACKS LEFT SETBACKS RIGHT _
PLAN CHECK NO.
)NE DEVELOPMENT NO Q 2C/2 r OS Q _�N CHECK FEES $