HomeMy WebLinkAboutXR2022-2342 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application �grF Comm] r Residential City of Newport Beach - Building Division (410"t`
/ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rVBuilding F_ Grading rDrainage F_Elec FMech F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood j— Fire F_ Liq F Landslide FN/A Floor Suite No
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Description of Work
Use R3 ConstType v 03
# StoriesT # Units (if Res)
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Valuation $ [_.(
Material/Labor 90 000
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New/Add SF �
��Q Remodel SF / Garage/New/Add I '/
OWNER'S NAME Last l-� First
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Owners Address
Owner's E-mail Address
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City �J-I V\- M�JC State G� Zip Telephone-
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APPLICANT'S NAME Last 13 L G CG P) +,7A 1 LL/First
Applicant's Address Applicant's E-mail Address
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City L J V1 State I V/ II Z(Q(p(7 -
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last QFirst Lic. No. F -
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ArchitectlDesigner's Address Architect/Designer's E-mail Address
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City I FU State 5 Zip �2t)31 Telephone —
ENGINEER'S NAME Last 6 COnSU � 0a First ��
L 7 it Lic. No.F—
Engineer'sAddress ��Q iVr1eE-4 A
n eemail A ress
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City 6I
State G Zip Gt 1-S Telephone 61 5 — 521- Lo
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CONTRACTOR'S NAME/COMPANY n , /1 Lic. No. F— ClassF_
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Contractors Address Contractor's E-mail Address
City State �- Zip �— Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO. 60 0?Z- ?j
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $