HomeMy WebLinkAboutXR2022-2102 - Permit ApplicationForm 'NVorksheet for Combo Building & Solar Permit Application
F Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [ Grading F-Drainage F_ Elec F_ Mech
F- Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) C Flood
I- Fire F_. Liq F_ Landslide FN/A Floor Suite No
F
Description of Work
Use F ConstType F
# Stories # Units (if Res)
-(F-LE -j'1ti7o FRFN-M Avo/LS i.J/ /.SLFoLL-, p>oo{LS,
N�oW - N Fku F1�2�EA-A P Doi d tl �C� L�Et
O
New/AddSFRemodelSF7_ Garage/New/Add
Valuation $
Material/Labor
III
OWNER'SNAME Last ( OE/J
First Ci/�a�ffff/v
Owners Address
Owner's E-mail Address
City I, State F—
Zip F____7 Telephoned
i
APPLICANT'S NAME Last —crv�—
r ,
First I�J�LL
Applicant's
Applicant's E-mail Address
/Address
City State G}�
Zip Telephone V [ ( 1 c.2 0�
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
_
city State �—
- -- -
Zip Telephone
ENGINEER'S NAME Last fA�rc�: � �q� l -
First �� f� p� Lic. No. /_? 3 Z
Engineer's Address
Engineer's E-mail Address
city ?UNN_ C/EL_ j State G�q -
- -
ZiP 77 Telephone�g)0e_ 5
CONTRACTOR'S NAME/COMPANY Lic. No. �so/ 3o Class I '-'
_—j - -
Contractors Address
Contractor's E-mail Address
City Lp ��U, kn ^'�� — - State 14,A—
/
Zip z( 7% Telephone 9y
rBA REAR SETBACKS FRONT
PERMIT NO..Z�x��
\ LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $