HomeMy WebLinkAboutX2022-0817 - Permit Application (2)Worksheet for Combo Building $ Solar Permit Application�E" �R>
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❑ Comm'I p( Residential City of Newport Beach -Building Division X.1071-011, o 9
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT�< oaN.
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Project Address (Not mailing address) ❑Flood ❑ Fire ❑ Liq ❑ Landslide Floor Suite No
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Description of Work
Use F-7 Const Type
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14A
MN V
# Stories❑ # Units (if Res)l
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Valuation $
Material/Labor
New/Add SF�� Remodel SF� Garage/New/Add -�
OWNER'SNAME Last -� First _—
Owner's Address Owner's E-mail Address
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City State ZIP u?�� Telephone hi4 1Z0
APPLICANT'S NAME Last ��I�LIA �---_-----� .First (..�,i1—k�- ---- - ---
Applicant's Address Applicants
EE--mail Address
City,y,t� State Zip 91�a' Telephone35d�
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ARCHITECT/DESIGNER'S NAME Last ��Q First `/I Lic. No.��
Architect/Designees Address Architect/Designer's E-mail Address
City J 4 � _ State Zip �� ( TO
ENGINEER'S NAME LastFirst Lic. No.
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Engineer's Address Engineer's E-mail Address
ateZip Telephone[�
CONTRACTOR'S NAME/COMPANY �L Lic. No. 0 f U r / y Class597
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Contractor's Address Contractor's E-mail Address
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City — - State r j Zip ' Telephone �f�p-_
SETBACKS REAR SETBACKS FRONT PERMIT NO. s
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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ZONE DEVELOPMENT NO 11A[X f - (Y N I ULAN CHECK FEES $ Gk!r+.