HomeMy WebLinkAboutX2022-1040 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application W�a>
rComm'] r/Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
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Project Address (Not mailing address) r Flood r Firer Liq r; Landslide rN/A Floor Suite No
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Description of Work
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# StoriesF # Units (if Resf
New/Add SFF— Remodel SF�—Ga
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Valuation
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OWNER'S NAME Last
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First
Owner's Address
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Owner's E-mail Address
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City =((---State
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APPLICANT'S NAME Last
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First
Applicant's Address
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Applicant's E-mail Address
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State r—
zip I Telephone wv S�
ARCHITECT/DESIGNER'S NAME
Last F— First F— Lic.
ArchitecUDesigner's Address
No. F—
Architect/Designer's E-mail Address
City F—
State r--
Zip F Telephone—
ENGINEER'S NAME Last
First �—Lic Nof—'
Engineer's Address
Engineer's E-mail Address
City ----. -----
State F—
Zip Telephone._.—_
ONTRACTOR'S NAME/COMPANY
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c No. /GZ� Classy
ontractor's Address
Contractor's E-mail Address
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City
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Zip �� �/y Telephone /i%Y
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.�
PLAN CHECK NO. 14,1 v "
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $