HomeMy WebLinkAboutX2022-1205 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application o4 E"°R>e
Comm'] City of Newport Beach - Building Division
r r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F
rBuilding rGrading
r,Drainage rElec rMech rplum CuydCut CuYdFill v
Project Address (Not mailing address) r Flood (— Liq - _ andslide rN/A Floor Suite No
S -
I A -AN R- U
Description of Work
Use F—ConstType F
# toriesF # Units (if Res
......
aluation $
Material/Labor
New/Add SFF—
Remodel SF
Garage/New/Add F ,
OWNER'S NAME
Last First
Owner's Address
ers E-mail Address
City
State �— Zip [_ Telephoned
APPLICANT' ME
First
Applicant' Ad
Applicant's E-mail Address
City
Zip 177. 1g�!'rY
.\ _. 4J.. ..
ARCHITECT/DESVRNE
Last First
Architect/Designe
Architect/Designer's E-mail Address
City
St t)AZi Telephoned
ENGINEER'S NAME
Last First F Lic. No.
Address
(7,Engineer's gineer's E-mail Address
�
City F kj
State �— Zip I Telephone
CONTRACTOR'S NAME/COMPANY p.li LO CoN5T2,_1 c rI oNJ I N G Lic. No. ) y Zq Class
Contractor's Address
Contractor's E-mail Address
n
�I� Smolt � Z� Nick Mtt.UCIiNST��tiGilOv-� lNc.cor1
City I S,}N State [� Zi yTele hone
p gZCrp `I`fcj'cIPi125118
-_
- 1705
SETBACKS REAR
SETBACKS FRONT PERMIT NO. ( -
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK N '
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $