HomeMy WebLinkAboutXR2022-2821 - Permit ApplicationI Print Form _I Worksheet for Combo Building & Solar Permit Application 1
rI/Comm'I residential City of Newport Beach - Building Division �(�. ��� '
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood r Fire f. Liq r Landslide F_N/A Floor Suite No
Description of Work j,(/,g/2- /� l fZ� s, yc
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Use __ �, Const Type ��
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# Stories # Units (if Res) F%
Valuation $`-
Material/Labor �j �' eO
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New/Add SF�— .."el SF Garage/New/Add �—
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OWNER'S NAME Last co First
Owner's Address Owner's E-mailAddress—
._...._-__ _.-_.-_._..__
City State F_Zip
Telephone
APPLICANT'S NAME L�A�� i Last First
Applicant's Address Applicant's E-mail Address _
City 8,A,G�,4 r��A/t1J� State — Zip 2. Telephone --- a-.-- _
ARCH ITECT/DESIGNER'SNAME Last First First/� Lic.N
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Architect/Designer's Address Architect/Designer's E-mail Address
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City S Telephone
ENGINEER'S NAME Last First F Lic. No.���
Engineer's Address Engineer's E-mail Address
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city State �® Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F_— Class
Contractor's Address Contractor's E-mail Address
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City StateF7 Zip I Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. XffZ0?,2 " Z 4z'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $