HomeMy WebLinkAboutXR2022-2903 - Permit ApplicationI Print Form I Worksheet for
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Combo Building & Solar Permit Application Y-- o' 4
City of Newport Beach - Building Division
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
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OWNER'S NAME Last k�`�
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last p
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Applicant's Address
Applicant's E-mail Address
City State F
Zip F— Telephonerl q S? '�
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ARCHITEC SIGNER'S NAME Last
FirstLic. No. F_
Architect/Designer's Address
Architect/Designer'sE-mail Address
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Zip I 55-3 Telephone C-i��l
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ENGINEER'S NAME Last s lea
First h l � � Lic No.C/ 15
Engineer's Address
Engineer's E-mail Address
City State FC;
Zip 0� SUZ Telephone (qS, )SZZ 2 837�
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City I State F
Zip F_ Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC.7,ay2
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $