HomeMy WebLinkAboutXR2022-2572 - Permit ApplicationL PrintForm ]]Worksheet for Combo Building & Solar Permit Application U�M
(— Comm Resid fR aY `? ? _ / LCity of Newport Beach - Building Division
NOTE: PLAN CHECK FFFR m iF aT Tinn❑ n❑ ci IDnn MIA1
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F-Building i-Grading F—Drainage F—Elec F-Mech PlumCu Yd Cut F Cu Yd Fill l_
Project Address (Not mailing address) 1- Flood - Fire i— Liq (— Landslide F—N/A Floor Suite No
l t1= f'?5y1_ZG c t: &zvGozT � �Hcry 9�tv�_� F- r--
Description of Work
Use s ConstType s
# Stories # Units (if Res)s
Zoo I�
New/Add SF �' Remodel SF
-(} -�e
Garage/New/Add F —
Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State �_—
Zip F_ Telephoned--
Last /dUYt First
L7 ��3f(ahZ
Applicant's Address
Applicant's E-mail Address
City YI EG ?G[ZT T 74C1{ State C A
Zip Telephone Z/// `g5p —
OnC 63
ARCHITECT/DESIGNER'S NAME Last
KT�Architect/Designer's
First F Lic. No. �—
Architect/Designer's Address
E-mail Address
City State F_
Zip �— Telephone
ENGINEER'S NAME Last
First Lic Nos --
Engineer's Address
Engineer's E-mail Address
City State F®
Zip �— Telephoned----
CONTRACTOR'S NAME/COMPANY /n✓lA�G7�
t�LVG��rLh Lic No. �j�S��L/ Class
Contractor's Address
Contractor's E-mail Address
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o nn
City yl e7o, i 1Z i T,1_—%L State FEA
Zip Telephone (�
SETBACKS REAR SETBACKS FRONT
PERMIT NO., k� C 2SZ
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $