HomeMy WebLinkAboutX2022-0669 - Permit ApplicationProt Forrn W `ksh"t for Combo Building & Solar Permit Application q7,City ofNewport Beach - Buildin Division
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Project Address (Not mailing dress) / i Flood /Cj'cFire [ Liq [Landslide I 'NIA Floor
Suite No
Description of Work r, I ,, , , , /y- - r , - - — 1 Use -1 d{-f[f�E�onst Type Q-nt
New/Add SF Remodel SF C 151 I Garage/New/Add—�
OWNER'S NAME
Last
# Stories1l.,If Units (if Res)CI
Valuation $
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Material/Labor
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Owner's Address Owners Email Address
City i p0we, I State
Zip r� Telephone � 977
APPLICANT'S NAME Last ( i//,M 1 First
Applicant's Address - Applicant's E-mail Address
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City State Cj'� I Zip II+b7i Telephone
ARCHITECT/DESIGNER'S NAME Last �' ''p j First >� �(�
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ArchitecUDesigner's Address
City �Jyi% G� i�?t` i State i
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Lic. No- G.1 I 6/
Architect/Designer's E-mail Address
zip 2(7tJ Talephonel Q C�b�� G �4
ENGINEER'S NAME Last First I Lic No.
Engineer's Address
City State
Engineer's E-mail Address
Zip Telephone[
CONTRACTOR'S NAME/COMPANY 1
Lic No. F—i Class
Contractor's Address
City - : State
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
- I
Zip �- Telephone
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
PLAN CHECK NO-