HomeMy WebLinkAboutXR2022-3266 - Permit ApplicationPrint Form ) Worksheet for Combo Building & Solar Permit Application a (�omm'I jCAesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [ Flood F_ Fire I— Liq F_ Landslide FN/A Floor Suite No
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Description of Work 14//1 /7T/c nA7 111,l ,
Use/iConstType V �%
# Stories-J # Units (if Res)T
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Valuation $
Material/Labor 2
New/Add SF�— e SF 2J S _ Garage/NLW/Add �_
OWNER'S NAME Last" /n6- /�1 � Ce
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Owner's Address Owner's E-mail Address`"
City - State �— Zip �— Telephone
APPLICANT'S NAME Last 77—> 0 ix- First ,_i/y
Applicant's Address Applicant's E-mail Address
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City P��T✓�J�� --ANC - State— Zip ��6�Z.. Telephone
ARCHITECT/DESIGNER'S NAME Last J7JJ �i✓l ep-/ First
_L`?J �y Lic. N -
Architect/Designer's Address Architect/Designer's E-mail Address
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City State Zip TelephoneF—
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State �� Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY f:� Lic No
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Contractor's Address o ractor' E-marl Address
City I State F Zip Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO. r1 1V W t"-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 14V •%J I to
USE ZONE DEVELOPMENT NO PLAN _CHECK -FEES $