HomeMy WebLinkAboutX2022-1022 - Permit ApplicationPrint Form Worksheet for Combo Building& Solar Permit A lic o 92,10,
r] Comm'I Residential City of Newport Beach - Building Division ( / ppNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
•.M
F, -Building Gradin
� 9 � 9
Draina a Elec Mech � Plum cued Cut Cu Yd Fill
[ J 9 � r, �,
J
-
Project Address (Not mailing address) ❑ Flood r Fire n Liq r Landslide F_jN/A Floor Suite No
17-77 F
Description of Work
j2
Use ConstType
# Storiesr # Units (if Res)
Valuation
Material/Labor
I
--- - --- - -- -1
New/Add SFF 1
_,
RemodelSF[ J Garag a/New/Add�
OWNERS NAME
Last First
Owner's Address
Owner's E-mail Address
City
State Zip I Telephoner
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
State Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last 'First
U r" Lic. No. - -
-- -'
Architect/Designees Address
Architect/Designer's E-mail Address
J
City State Zip Telephoned
ENGINEER'S NAME
Last - First Lic.
Engineer's Address
Engineer's E-mail Address
City _
;
State Zi Tele hone
P -- p
CONTRACTOR'S NAME/COMPANY Lic. No. Class OMA F
Contractor's Address
(�
Contractor's E-mail Address
I
-- -
City
- -
State r 11 Zip � Telephone I__
SETBACKS REAR SETBACKS FRONT PERMIT NO. J r " 24-' 166`
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Oq O? •Upl
I13F 70NF nolo ^MRACKIT Kin 01 AAI nUi=nV =M0 0