HomeMy WebLinkAboutXR2022-3201 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Application
Comm'[ r/<Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F- Flood r Firer Liq j-- Landslide rN/A Floor Suite No
Description of Work
New/Add SFF— Remodel SF� Garage/New/Add �—
OWNER'S NAME
Owner's Address
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city
Last
Use � ConstType
# Storiesw
16o #Units (if Res)[—
Valuation $ F
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Owner's E-mail Address
p-I StateI Y(_ Zip
APPLICANT'S NAME Last FGnry rvu_v�__2_ First ��—
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Applicant's Address Applicant's E-mail Address
City yl, State ZipTelephone C�L� �;
ARCHITECT/DESIGNER'S NAME /
Last First—
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State r Zip !-- TelephoneF�
ENGINEER'S NAME Last I First
Lic Nc
Engineer's Address Engineer's E-mail Address
City State F Zip IF— TelephoneF�
CONTRACTOR'S NAME/COMPANY Lic. No. 773
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Contractors Address / Contractor's E-mail Address
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City �� it.� s State `� - — Zip 7 Telephone C ' ' c
SETBACKS REAR SETBACKS FRONT PERMIT NO. V
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N -
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