HomeMy WebLinkAboutX2022-1631 - Permit ApplicationI Print Form Worksheet for Combo Building & Solar Permit Application
r' Comm'I j- Residential City of Newport Beach - Building Division t
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j Building rGrading F-Drainage j-Elec I-Mech
('Plum cuYdCut F CuvdFill F
Project Address (Not mailing address) f Flood r Fire j- Liq r Landslide FN/A Floor Suite Nc
�am�2�25 F— �—
Description of Work
Use F— ConstType
# StoriesF— # Units (if Res)F_
Valuation $
New/AddSFF_ Remodel SFF—Garage/New/Add
Material/Labor
OWNER'S NAME Last
First
Owner's Address
r
Owner's E-mail Address
City r State �—
Zip F— TelephoneF—
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F_
Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last (, 1 2 First J- Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
510 l�arkhhSp(�r .A��
W//CL)-Z r a�, M I. Cvti-\
City � (`p/ACn ' J/ P 1 Lk0,p State ,
/ 7
Zip qZ( 22,5 Telephone q 4 j D S 4, rjef r -7
ENGINEER'S NAME Last �
First F Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F
Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic. No. F_Class
Contractor's Address
Contractor's E-mail Address
City State F
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.��
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZOIE _ _ __ _ DEVELOPMENT NO