HomeMy WebLinkAboutXR2022-3349 - Permit Application1 _ Print Form Worksheet for Combo Building & Solar Permit Application
r Comm] j— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building r Grading F—Drainage rElec rMech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
r Fire j— Liq r Landslide F_N/A Floor Suite No
�6S CG�e -Tr—
ri e,) PdQ
Description of Work
Use F—ConstType
Nome
# StariesF—:z- #Units (if Res)
Valuation $
Material/Labor /Q6 / p tic
New/Add SF lAC Remodel SF 1— Garage/New/Add
OWNER'S NAME Last (7 First C (f r
Owner's Address
Owner's E-mail Address
CGtes�-vtU t- (a(e
City )jec)PO)2_ 31 .paC ( State G�
v
Zip (fj�66v Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City I State �—
Zip F TelephoneF_
ARCHITECT/DESIGNER'S NAME Last F_—
First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F Telephone F_
ENGINEER'S NAME Last
First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I State �—
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class!
Contractor's Address
Contractor's E-mail Address
City I State �—
Zip F_— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X )Z Z OZ Z- S3 \'zk,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $