HomeMy WebLinkAboutX2022-1139 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Appl—tion
r Comm'I r Residential City of Newport Beach - Building Division �I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding j- Grading
rDrainage r Elec r Mech
r Plum CuvdCut CuYdHII F
Project Address (Not mailing address) I— Flood
r Fire r Liq r Landslide rN/A Floor Suite No
1 o�W
I
G
Description of Work
Use F Const Type F
# Stories[— # Units (if Res)F—
Valuation $
New/Add SFF_—
Remodel SFF Garage/New/Add F—
Material/Labor
OWNER'S NAME
Last
First
Owner's Address
Owners E-mail Address
City
State �—
Zip F— Telephoned
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State F___
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last rt
First {,.f1� Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address C S
City I
State �—
Zip F Telephoned
ENGINEER'S NAME
Last
First F_ Lic. No.F_
Engineer's Address
,�1
Engineer's E-mail Address 02 LM o �1
DPI 3` I v
City
State F_
Zip F_ Telephone 0 ooj�a
CONTRACTOR'SNAME/COMPANY SWt/fGl D po�n�l I divSky Lic. No. 000.fof Class
Contractor's Address
Contractors E-mail Address
11 � worcr Aye
cvlel - Upofi#�i 10 g�s/vs�i�
City 1 oS , r% State
Zip �Z �� Telephone 7/y- �j d -6 3Sf
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. y3z7-II7-1
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.ID'fb -
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $