HomeMy WebLinkAboutX2022-0030 - Permit Applicationx 20-? , �- 003 �OL)U AA&,G e�v+�,�1 Clvc�
Print Form Worksheet for Combo Building & Solar Permit Application �6W�
rV60mm'I r Residential City of Newport Beach -Building Division 3
NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o.+
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Project Address (Not mailing address) Flood (- Fire F- Liq I— Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType F—
ff Stories # Units (if Res)
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Valuation $ `� -,l 000
Material/Labor
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New/Add SFF Remodel SF F— Gara9a/New/Add F
OWNER`S NAME Last I1' c? dfG"= First
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Owner's Address Owners E-mail Address
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APPLICANT'S NAME[(
Last First �4TdL%"L�1x¢f
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First 56i t5 Lic. No. r
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Afehitecb'Designer's Address ArehitsGUDesigner's E-mail Address
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ENGINEER'S NAME Last jk((gGuaj Firstc: / Lic. Not_____r
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Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY Lic. No. cGO; p , Class C ty n
Contractor's Address Contractor's E-mail Address
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City SR ulyG1 ��1^-� ` State F77—Zip Z : Telephone T'( - E 4`/ G c E y
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5 --[BACKS REAR SETBACKS FRONT PERMIT NO.
SET BAgKS LEFT SETBACKS RIGHT PLAN CHECK N0.