HomeMy WebLinkAboutXR2022-2269 - Permit ApplicationPrint Form Wa q,
_ Worksheet for Combo �Laiia�irog &Solar Permit Application
City of Newport Beach - Building 1 ( Comm'I Residential gDivision
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Building F_ Grading F-Drainage F-Elec rMech f'Plum Cu Yd Cut l Cu Yd FillF_
Project Address (Not mailing address) C Flood r Fire F- Liq F- Landslide I —N/A Floor Suite No
Description of Work
Use F Const Type s—
# Stories # Units (if Res)s
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Valuation$ �i�«
Material/Labor �. '
New/Add SFF 3,B50, 6 Remodel SF �— Garage/New/Add N�
OWNER'S NAME Last C� n
%Y% Lam` First
Owner's Address
Owner's E-mail Address
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City- 8C%r State I `" - -.
- - -- - l -- -, ZiP,�,./ 7 Telephone F45-3G7_--igY
APPLICANT'S NAME Last /717® ITn S;ru Z First
Applicant's Address Applicant's E-mail Address
City FIV �t(/CJ 60CA State j74VIt- Zip � � Telephone Q,-q- 3G7—Z11/
ARCHITECT/DESIGNER'S NAME Last FPi�C First , V i Lic. No. C3905 _
Architect/Designer's Address Ar�chitect/Deesignerr''s E-mail Address
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City � � ,�rifS State � Zi i L /Z P a-+
P GZ Tele hone v?7l.
ENGINEER'S NAME Last F ®First s® Lic. No.F_
Engineer's Address Engineer's E-mail Address
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City F® State F_ Zip �- Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F Classs—
Contractor's Address Contractor's E-mail Address
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City State �— Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO "928 _ PLAN CHECK FEES $ Lemma'' D