HomeMy WebLinkAboutX2022-0918 - Permit ApplicationPrintForm j Wqft t for Combo Building & Solar Permit Application %�Ew° 0
[, Comm'I Residen al�j City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building [ Gradin - rainage r-Elec j Mech r Plum CuvdcutF-- CuvdFill F
Project Address (Not mailing address) Flood rl Fire q F_ Landslide CN/A Floor Suite No
Description of Work
Use F—IConst Type
ry
J/� ��-- 1 Y (� ,
VG'L-'rrr \ l II�CI.t. C-C�
# Stories # Units (if Res)FI
Valuation $
Material/Labor ( �✓; 000.
New/Add SF_/- Remodel SFF77 Garage/New/Add F
OWNER'S NAME Last �;m _ _ First -_-
Owner's Address/ Owner's E-mail Address
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City /t �G��off 45Pa State 54 Zip i 2G6/ TelephoneF77--
APPLICANT'S NAME Last r� fz9�P - _ - - First a��, -
Applicant's Address Applicant's E-mail Address
CPi7"%3�os
City State Zip 7 Telephone T7 7
ARCHITECT/DESIGNER'S NAME -'
Last - �'ui �r� I First LIC. No. �
Architect/Designer's AddrressG Architect/Designer's E-mail Address
City �C� - State Zip �� Telephoned
ENGINEER'S NAME Last 3/ ;First Lic. No. i
Engineer's Address Engineer's E-mail Address
/ ive) C= /G
City � �N^a -�, State Zi � Telephone—; �✓ k �
CONTRACTOR'S NAME/COMPANY Lic.No. 9OS�/d Class
77 /
Contractors Address Co/n�tractor's E-mail Address
`YGur- & l/K/�r�ai%�/'fXi
CityS1>v - - - State Fe4_ Zip�l Telephone Ti�G-3-?s G727
SETBACKS REAR SETBACKS FRONT PERMIT NO. x2 CF1 tg'
SETBACKS LEFT SETBACKS RIGHT dj PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $