HomeMy WebLinkAboutXR2022-2939 - Permit ApplicationL print Form Worksheet for Combo Building $ Solar Permit Application (00
F_ Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME nF GI IRNAITrAI XR1(11i 1439
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Description of Work
Use - ConstType -
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# Storiess # Units (if Res)
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New/Add SF 'J� Remodel SF
Garage/New/Add �—
Valuation $ oc
Material/Labor �
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City L _ State �' Zip 9�%I / fj Telephoner._—
APPLICANT'S NAME Last z FirstC151
Applicant's Address
Applicant's E-mail Address
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City State GA _
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ZIP pLI7JU Telephone 14Q'1�(o-2923
ARCHITECT/DESIGNER'S NAME Last h/�OU
f-r RE4Jl
First CJ'E Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City A�Q � State �—
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Zip j�G61 Telephone---
ENGINEER'S NAME Last
First -_ Lic. No.�—
Engineer's Address
............. ...
Engineer's E-mail Address
City State �®
Zip �— Telephone—
CONTRACTOR'S NAME/COMPANY � � (
Lic. No. ga3I7.5 Class
Contractor's Address
Contractor's E-mail Address
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City I C 14 l l I U State CA
Zip Telephone-,Zq(p ..� 92 ?j
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. A61W - Zp:�Zl
USE ZONE DEVELOPMENT NO PLAN CHECK FEES