HomeMy WebLinkAboutX2022-1660 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�NFWP0"
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City of Newport Beach - Building Division( 2� . (t� O
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i" "<.FaaNP
F_ Building F Grading j-Drainage j- Elec r Mech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ r Fire F_ Liq r Landslide f_N/A Floor Suite No
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Description of Work
Use 5 F Const Type Conn.
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# StoriesF3 #Units (if Res)
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New/Add SF1 Remodel SF -' Garage/New/Add F�
Valuation $
Material/Labor %rx&_.
OWNER'S NAME Last I ' Aj.I NE. N aA U N� First H �
Owner's Address Owner's E-mail Address
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City I j"' "J State C A Zip 1 O5 Telephone q49 3151571
APPLICANT'S NAME Last W -n &,21 v First T LO1z.IN
Applicant's Address Applicant's E-mail Address
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City -1 \,ru- T,i,1 DE: State L'-A Zip g2-U50 Telephone $5$ 353 027q
ARCHITECT/DESIGNER'S NAME Last �First c,"2ISTOPHEK Lic. No. C-1gJ15'
Architect/Designer's Address Architect/Designer's E-mail Address
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City t"1ec 0LA v State CA Zip Iq'LsqA, Telephone 51.�i5,y2m
ENGINEER'S NAME Last First F Lic. No.�
Engineer's Address Engineer's E-mail Address
City State �� Zip Telephoned
CONTRACTOR'S NAME/COMPANY ��/ r� C � �T�U Cfi101.j lxkc , Lic. No. fj 13(� Class I l'
Contractor's Address Contractor's E-mail Address
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City Co 'ONA State FA Zip I c12g- ! Telephone V58 3�3 0279
X4022. - 1640
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. So 6 •QZ(j ZZZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 5 1 S