HomeMy WebLinkAboutX2022-1604 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application � oa>
r Comm] r Residential City of Newport Beach - Building Division .4
NOTE: PLAN CHECK FEFS n11F AT TIRAF nF si innniTToi
rBuilding r Grading rDrainage r Elec r Mech r Plum Cu vd cur Cu vd Fill
Project Address (Not mailing address) IF Flood IF Firer Liq I— ide rN/A Floor Suite No
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Description of Work
Use Const Type �—
tl�?ru1 q—
fit- I
# StoriesF # Units (if Res)[
Valuation $
Material/Labor
New/Add SFF— Remodel SF7—
Garage/New/Add F—
OWNER'S NAME Last TV Qt.0 F-A�•Z�.�&o
First C il�(i C_
Owner's Address
Owner's E-mail Address
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City 1 0 (j State F `�'�
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Zip "IpfO Telephone�—
APPLICANT'S NAME Last ,
First V;g;> —
Applicant's Address
Applicant's E-mail Address
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City ql-x yState I (
Zip %[ `3 Telephone (I+5--j(�rES
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ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
city State F
Zip �— TelephoneF—
ENGINEER'S NAME Last
First F_ Lic. No.1—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY �Q� 1 ,.. � Lic No. Class ( 7_
Contractor's Address
Contractor's E-mail Address
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City Q.Li%W State �—
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ZipTelephoneMr{'(0f
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
`^p PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
1 s _ N CHECK FEES $