HomeMy WebLinkAboutX2022-0721 - Permit ApplicationPrint Form Worksheet for Combo Building $ Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_ Grading F-Drainage F_ Elec F_ Mech
r Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) i— Flood r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work G�
Use F—ConstType
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n tTA9 �� CQ
#Stories[— # Units (if Res)[—
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p, M_�r.a
New/Add SF F_Remodel SFGarage/New/Add F—
Valuation $ O Q O
Material/Labor 1
OWNER'S NAME Last bosf I S1CO Y1�� S
First
Owner's Address
Owner's E-mail Address
City Oy 0, State C_N
Zip �Z(o(o3 Telephone
APPLICANTS NAME Last
First
Applicant's Address
Applicant's E-mail Address
mz
MA\,,,
city��0.� State I cP,
Zip q(� Telephone
ARCHI DESIGNER'S NAME Last
Fi Lic. No.
ArchitecUDesigner's Ad ss
Archite esigner's E-mail Address
City I State F
Zip F— Tele oneF
ENGINEER'S NAME Last
F' t Lic. No.F
Engineer's Address
ngineer's E-mail Address
City State
Zip F TelepfioneFl
CONTRACTOR'S NAME/COMPANY �YO\��Jr\cOn`1by,\Lic.No. q$93}� Class
Contractor's Address
Contractor's E-mail Address
b1v -2-z \
City �b�h� State Q N
Zip c�_,-,( , Telephone �I�- 33q-�V44
251-1 '^ 0
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X 27 -0'7 Z
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE "�uX) / '772-41EVELOPMENT NO 17 Zd2Z_ 01 Z'{ PLAN CHECK FEES S �-7 f f 7 n 7