HomeMy WebLinkAboutXR2022-3246 - Permit ApplicationL - Print Form Worksheet for Combo Building & Solar Permit Application QUA
F Comm'[ Residential City of Newport Beach - Building DivisionNOTE: PLAN CHFCK FFFA ni iG vT Tinny nr c, lone ,r ,
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IiRuilding F_ Grading j-Drainage F Elec F Mech F- plum
f" Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) 1- Flood F_ Fire F_ Liq r ndslide 1-N/A Floor Suite No
Description of Work
Use F— Const Type F—
# Stories # Units (if Res)s
Valuation $
Material/Labor
s--
New/Add SF Remodel SFs Garage/New/Add s--
OWNER'S NAME Last c
I l7 L, 6c� First
Owner's Address
Owner's E-mail Address
City Jf( IGJv7q-r (jet W State r Zip T� -7 Telephone 7 14 5o(-�9%3
APPLICANT'S NAME Last AP 41e I U) First E 4.4L p 5
Applicant's Address Applicant's E-mail Address
Z(I3
City ,� q ��li}- A-IJ 4 State �— Zip z Telephone (¢ (q44- 60 ( �
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ARCHITECT/DESIGNER'S NAME Last �j�kL/khn 4Ffq.<,� rnl First F5
I4'.1 Lic No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Telephone—
ENGINEER'S NAME Last `
�`J _ First 0.,'✓� l Lic No.F—
Engineer's Address Engineer's E-mail Address 2 7 7
City F� State F Zip F_ Telephone—
CONTRACTOR'S NAME/COMPANY/(_ �G� 0 Lic No. 0(,,7546 Class�-
/�
Contractor's Address Contractor's E-mail Address
Z((S t - P iwc-
City �AJTA State l( - Zip r %Z7d(, Telephone 7(4 (P ¢¢ /Y1IL
SETBACKS REAR SETBACKS FRONT PERMIT NO. A �OW - _;a,q 6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $