HomeMy WebLinkAboutXR2022-2260 - Permit Application- Print Forrnj Worksheet for Combo Building & Solar Permit Application
COmm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Address (Not mailing address) C Flood Fire I Liq r Landslide rN/A Floor
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ascription of Work
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2-5, 3c-3
New/Add SF �—
OWNER'S NAME
Owner's Address
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Remodel SF �—
Last
Garage/New/Add I
Owner's E-mail Address
Suite No
Use [_ Const Type
# Stories[— # Units (if Res)r—
Valuation $
Material/Labor r
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City
State r
ZIP I Telephoned
APPLICANT'S NAME Last _
r�j r/Zc r First ��-
Applicant's Address
_ Applicant's E-mail Address LAI tcaw//C_C-ey- `54sc' State ZIP Telephone
ARCHITECT/DESIGNER'S NAME
Last pS5 First
Architect/Designer's Address
r/^r6- Lic. No. Vy
Architect/Designer's E-mail Address
/ _ --- - c-c/;w
City Zl
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S. p _ Telephone 7/Yi2
ENGINEER'S NAME Last
�Jc Ss First T tf Lic No.F—
Engineer's Address
- Engineer's E-mail Address
_1 I'i'r c�OSS Cy 15 A-1 A
city- -
State Zip Telephone �/r� �L4S%L�rY
CONTRACTOR'S NAME/COMPANY
Contractor's Address
02 Z_
City E}��v if ✓lfS
j'I�j%L C ✓ a�✓` a li Lic. No. G-hi Class C-�L
Contractor's E-mail Address 7 S5 ✓9
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State �— Zi
-- P 1 J 26513 Telephone�/ 7 51- y- 3 ,
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. ! V I l 2�0LL -Z2 Ll
PLAN CHECK NO. PL ziiz Z Z I U
PLAN CHECK FEES $