HomeMy WebLinkAboutXC2022-1895 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading []Drainage MElecp Mach Plum cu vd ut Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq [I Landslide I ;N/A Floor
Description of Work
r _ - Use ,!EA Conol
New/Add SF� Remodel SFGarage/New/Add
OWNER'S NAME Last
Owners Address ) �-
City _ �i State
APPLICANT'S NAME Last
First
Owner's E-mail Address
Zip
Applicant's Address
City QPMC(jj_ I State CZip
Suite No
14,-1
It Units (if Res)�11
ValuationS�^ J/ 2��
Material/Labor l T/ —1
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First
nt's E-mail Address
�j5 iZ7� Telephone
ARCHITECT/DESIGNER'S NAME i�
Last p)\(f�'_�7 ] First FZ(,(L i
Architect/Designers Address
City State
ENGINEER'S NAME
Lic.No G. VCjVT_N
Architect/Designers E-mail Address
-(-
ZiR 2Gb-u1 Telephone Cb(,�; C �
_ P 1�
Last �— - - - I First
Engineers Address
City _- State
Lic No.� J
Engineers E-mail Address
Zip Telephoned—(
CONTRACTOR'S NAMElCOMPANY 13�. PM/j Lic. No. F 1 Clas
Contractor's Address
WJ a5� t iw ! uy 5 g t J i
city _ _ - State j
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractors E-mail Address
Lp Telephon
PERMIT NO. )6C Zx_5ZZ — l S
PLAN CHECK NO.
PLAN CHECK FEES $