HomeMy WebLinkAboutX2022-0384 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL r"
Building F_Grading
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Projecc�t Address (Not mailing address) Flood F_ Fire j5/Liq Landslide (—N/A Floor Suite No
Description of Work
Use F—Const Type F
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# Stories #Units (if Res)
Valuation
Material/Labor �!
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New/Add SFF
Remodel SFF Garage/New/Add F—
OWNER'S NAME
Last First I
Owner's Address
Owner's E-mail Address
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City (
State ' v �S
Zip �— Te ephone (146
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APPLICANT'S NAME
Last / First
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Applicant's Address
Applicant's E-mail Address
City �A \ ,
State F27F Zip �� 3 Telephone
ARCHITECT/DESIGNER'S NAME Last) First �{ f i Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State I Zip TelephoneF
ENGINEER'S NAME
Last �� r� i First l � Lic. No. E
Engineer's Address
E-mail Address
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City C State Zip7 v� Telephone 7 �I `) . 3e
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CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City �—
State F— Zip �— TelephoneF
SETBACKS REAR
SETBACKS FRONT PERMIT NO. Xf-vZ2- -060_�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 0S•4o . f022
USE ZO'iE __
_ DEVELOPMENT NO PLAN CHECK FEES $ _
Community Development Department
CITY OF NEWPOR. BEACH
Planning Permit Application
100 Civic Center Drive
Newport Beach, California 92660
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949 644-3200
newportbeachca.gov/communitydevelopment
1. Check Permits Requested:
❑ Approval -in -Concept - AIC #
❑ Lot Merger
❑ Staff Approval
❑ Coastal Development Permit
❑ Limited Term Permit -
❑ Tract Map
❑ Waiver for De Minimis Development
❑ Seasonal ❑ < 90 day ❑>90 days
❑ Traffic Study
❑ Coastal Residential Development
❑ Modification Permit
❑ Use Permit -[]Minor ❑Conditional
❑ Condominium Conversion
❑ Off -Site Parking Agreement
❑ Amendment to existing Use Permit
❑ Comprehensive Sign Program
❑ Planned Community Development Plan
❑ Variance
❑ Development Agreement
❑ Planned Development Permit
❑ Amendment -❑Code ❑PC ❑GP ❑LCP
❑ Development Plan
❑ Site Development Review - ❑ Major ❑ Minor
5q Other: lJ
❑ Lot Line Adjustment
❑ Parcel Map
2. Proiect Addresses)/Assessor's Parcel No(s;
3. Project Description and Justification (Attach additional sheets if necessary)
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4. Applicant/Company Name W
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Suite/Unit
Mailing Address
city �
State
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Zip l �_
Phone
Fax I /
Email,
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5. Contact/Company Name
Mailing Address
uite/Unit
City
State F
Zip !�
Phone Fax
Property Owner Name 1 f V�
Mailing�Qddres L L �� w. (7Ge'Un.VL�r1}— I Suite/Unit
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City I State Zip
Phone I Fax Email
7. Property Owner's Affidavit*: (1) (We)
depose and say that (I am) (we are) the owner(s) of the property (ies) involved in this application. (1) (We) further
certify, under penalty of perjury, that the foregoing statements and answers herein contained and the information
herewith submitted are in all respects true and correct to the best of (my) (our) knowledge and belief.
Signature(s):
Signature(s):
Title: I Date:
MM/DDNEAR
Title: I Date:
*May be signed by the lessee or by an authorized agent if written authorization from the owner of record is filed concurrently with the
application. Please note, the owner(s)' signature for Parcel/Tract Map and Lot Line Adjustment Application must be notarized.