HomeMy WebLinkAboutXR2022-2369 - Permit ApplicationPrint Form__ Worksheet'for Combo Building & Solar Permit Application aF� W°tea>i
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEF6 FN IF AT TIRAP OG ci ioAAIT Al
wilding rGrading F—Drainage j—Elec F_Mech j—Plum Cu Yd Cut[_ Cu Yd Fill
Project Address (Not mailing address) F— Flood Fire F_ Liq r Landslide F_N/A Floor Suite No
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Description of Work
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Use Const Type
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#Stories L #Units (if Res)
Valuation $ : O
Material/Labor I�
New/Add SF f Remlodel SF G � �
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OWNER'S NAME Last �r��n� j`C- First
Owner's Address
Owner's E-mail Address
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City C'J nPl, f✓A- State C i� Zip t �(�) Tele hone G'
APPLICANT'S NAME Last i ,j-,7,6U> First n a
Applicant's Address
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rz Applicant's lc�aln.tE--_mail Address
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City State Zip "OEtETelephone —52_o_
ARCHITECT/DESIGNER'S NAME , �n
Last '1V V✓Lt�n nI First NiLit�l Lic. No. C_3�
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Architect/Designer's Address Architect/Designer's E-mail Address
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City jGIRS�� iC`t^ State �t Zipen
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ENGINEER'S NAME Last LGC%r$�"�/ First ����Q, Lic. No. � 3 �,2
Engineer's Address Engineer's E-mail Address
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City State C Zip C25I Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. 6
R317 Class
Contractor's Address Contractor's E-mail Address
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Clh' State F_ Zip �— TelephoneF�
SETBACKS REAR SETBACKS FRONT PERMIT NO. >CRZQtz Z 3 6q
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. pl ? 22L 1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $