HomeMy WebLinkAboutXR2022-2291 - Permit Application_PrinrForm �aVorksfaeet for Combo Building &Solar Permit Application ('02.2
F— Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME nF .RI IRMITTAI —
j�Building F_ Grading F—Drainage j—Elec FMech Plum CuYdCut � cuYdFill
/Project
Address (Not mailing address) r— Flood F_ Fire F_ Liq j_ Landslide I —N/A Floor Suite No
't161 W-fuf 0/1 _ _ I F_
Description of Work
Use Const Type F_
# Stories[ # Units (if Res)r
Valuation $
Material/Labor) W
New/Add SFF- Remodel SFF— Garage/New/Add �—
OWNER'S NAME Last y First
Owner's Address Owner's E-mail Address
City State F Zip F777— Telephonef ----
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F Zip Telephone �—
ARCH ITECT/DESIGNER'S NAME Last First
Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City F State �— Zip Telephoner
ENGINEER'S NAME Last F� First F Lic. No.
Engineer's Address Engineer's E-mail Address
r
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY / j
_ Lic. No. �3t�2� Class
Dt' CiCOorittractor's
Contractor's Address E-mail Address
I
City I State F_ Zip Telephone��
SETBACKS REAR SETBACKS FRONT X��� ��
PERMIT N0. '1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO944t;
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $