HomeMy WebLinkAboutX2022-1391 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oIM
[- Comm'I [- Residential City of Newport Beach - Building Division o
NOTE: PLAN (wu : FEES DUF AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [- Flood re (- Liq [-Landslide FN/A Floor Suite No
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Description of Work
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Valuation 5 �I,
Material/Labor 'C 25,X
OWNER'S NAME Last F[Z-I
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Owner's Address
Owner's E-mail Address
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City N ,01 r 5-1
State I CA" Zl �2,L5_] Telephone jL�t�
APPLICANT'S NAME Last
First 1 '51E11E
Applicant's Address
Applicant's E-mail Address
Zg5'II SOUTI;IiA�(�Tc,-t
C"1 S"fE.le�' STA�4htl�tli71 CyS. c��
City I 60r�, �LA s
State Fa7__ zipRi_b53 Telephone WI _ 01-q3V+
ARCHITECT/DESIGNER'S NAME
Last s Fyn First S TEvE Lic. No. (- 2q LI S
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Architect/Designer's Address
Architect/Designer's E-mail Address
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51'EyE � 5 vMiq {I-OCr}rrEG�S . ��
City �GV4 L.S
State I l� Zip 13153 Telephone iAq- G71-`i3C4
ENGINEER'S NAME Last
Grin EDS First 6;;6-c Lic. No. 'j'7 o q G
Engineer's Address
Engineer's E-mail Address
ZZII j11C�fAs�,1 P RNE SutTf. 450 13@ -P)ceM,ccM
CityFii�_k_E
State F_cT Zip Oj2LIZ Telephone l41 T52-060I
CONTRACTOR'S NAME/COMPANY
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Contractors Address
Contractor's E-mail Address
Ci �r , J iV Can
State Ci ZipFeTz Telephon q
REAR 6 /
SETBACKS FRONT O% , PERMIT NO. u-
VS
TCKS LEFT 0SETBACKS
RIGHT t C> /PLAN CHECK NO.'01 �'
USE ZONE "
DEVELOPMENT NO PLAN CHECK FEES $