HomeMy WebLinkAboutXR2022-2867 - Permit ApplicationPrint Form_ _ Worksheet for Combo Building & Solar Permit Application
F- Comm'I esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building F_Grading F-Drainage _Elec F_Mach
F Plum Cu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) F_ r Fire F_ Liq r Landslide F_N/A Floor Suite No
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Description of Work
2
Use ConstType
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N Pyv ADv 6+ fivvt-+ 3ti S s r
# StoriesF # Units (if Res) F,
Valuation$
Material/Labor I , 00(:)
New/Add SF V Remodel SF Garage/New/Add �—
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OWNER'S NAME Last �l
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First I�,Q
Owner's Address
Owner's E-mail Address
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City o yvo(A DC' ,v M r State n
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Zip Telephone 71 ,11 S7DC7
APPLICANT'S NAME Last rV I I Vl
First C zy_'vf - t-
Applicant's Address
Applicant's E-mail Address
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City �l Yrl S State CA
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Zip Gj 25" �(� Telephone rEl-3 73�Z) S
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ARCHITECTMESIGNER'S NAME Last n/ First F Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip �— Telephone�—
ENGINEER'SNAME Last �jahyytGlY� First MokS�L Lic.No.�C—�2-
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Engineer's Address
-
Engineer's E-mail Address
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City C0 V,o State
Zip a l Telephone 2`3. �C. w 0
CONTRACTOR'S NAME/COMPANY l
1
Lic. No. �— Classr—
Contractor's Address
Contractor's E-mail Address
City State F
Zip Telephoner
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO `5701,y •0201 PLAN CHECK FEES $