HomeMy WebLinkAboutXC2022-2003 - Permit ApplicationPrint Form 1; I ti
--- - - --� Y'Vorksheos fO�° Combo Building & Solar Permit Application �EWPOR�
Comm1 �` Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL � �
Building F` Grading_ plum
( Drainage F_ Elec F Mech um F
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Project Address (Not rnaoping address) Flood Fire F` Liq f" Landslide j-N/A Floor
Suite No
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Description of Work
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V #Storiecr— # Units (i`Res)
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New/Add SF Remodel SF Valuation $
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OWNER'S NAME --
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Last _.�.� � ,First
Owner's Address
Owner's E-mail Address
City
State
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Telephone '
APPLICANT'S NAME Last Q/
First
Applicant's Address
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Applicant's E-mail Address
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city -- Zip _�. Telephone
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ARCHfTECT/DESIGNER'S NAME _
Last First Architect/Designer's Address -
Lic. No.
Architect/Designer's E-mail Address
ity Zip -
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_ p �— Telephone
ENGINEER'S NAME Last 1
'�4�1��r1� ..�'L�'�_��'Gpyf•jirst _ _ _ Lic. No.
Engineer's Address U
Engineer's E-mail Address L 7
City
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Zip/
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
,s Contractor's E-mail Address
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City l,Gta/[GLG State _._.._
_ Zip 7� - Telephone
SETBACKS REAR 300'�1ty
SETBACKS FRONT -
PERMIT NO. Ic
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE ( 7 Z�SL2 —25