HomeMy WebLinkAboutX2022-1639 - Permit ApplicationPrint Form Worksheeff6ir Combo Building & Solar Permit Application
F_ Comm'I fv` residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building [Grading F—Drainage [Elec F_Mech F_Plum CuvdCut CuYdFill F
Project Address (Not mailing address) C Flood [ Fire F_- Liq [_ Landslide 1-N/A Floor
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Suite No
Description of Work / Use Const Type F
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T Valuation $
New/Add SFFV5/ Remodel SFFVfy Garage/New/Add l-..-,- Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City �_ > Z, ,f � State ��� Zip Telephone
APPLICANT'S NAME Last
Applicant's Address
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City Qh< State
ARCHITECT/DESIGNER'S NAME
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Architect/Designer's Address
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ENGINEER'S NAME Last I /r,�p rz�r_j-
Engineer's Address
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First _4��t 1.
Applicant's E-mail Address
Zip rj 29 Telephone
First Lic. No. G
Architect/Designer's E-mail Address
Zip Z7OS Telephone _
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First
Engineer's E-mail Address
Zip Telephone 7/c/
CONTRACTOR'S NAME/COMPANY /I / Lic. No. %�(g6C� CICIass
Contractor's Address
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City Qr` �Se State
SETBACKS REAR
SETBACKS FRONT
Contractor's E-mail Address
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PERMIT NO. � ,//& ['10
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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