HomeMy WebLinkAboutX2022-0285 - Permit Application (2),,ft,, Form . _ Worksheet for Combo Building $ Solar Permit Application
n Comml r Residential �j Z2 `02 g-5City of Newport Beach - Building Division SOS LccG4 e J �l
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �7
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Project Address (Not mailing addres
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of Work
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❑flood Fire Liq Landslide �N/A Fllloor Suite No
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# Stories7_ # Units (if Res)
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Valuation $F(O-
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New/Add SF�� Remodel SF Z S Garage/New/Add L Material/Labor
OWNER'SNAME Last
Owner's Address
First
Owner's E-mail Address
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APPLICANT'S NAME Last 11\G!,rge-y-
Applicant's Address
City - - - --- - State
First
Applicant's E-mail Address
Zip Telephoned J
ARCHITECT/DESIGNER'S NAME Last �— j First
Architect(Designer's Address
City _- -- State t
Lic. No. �J
Architect/Designer's E-mail Address
Zip Telephone[ - ---------
ENGINEER'S NAME LastJ First [ Lic. No.�
Engineer's Address
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City �— i State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
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CityIS�L{�!l State �-
Engineer's E-mail Address
ZIP Telephone
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Lic. No. I �brJrl S�i7 1 Class
Contractor's E-mail Address
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Zip ql Telephone CQ25) 3l)- jR31
PERMIT NO. X202Z. -OZ$ 5
PLAN CHECK NO. OZ SS - Zd'ZZ-
PLAN CHECK FEES $