HomeMy WebLinkAboutX2022-0764 - Permit Application (3)'j6 f)3 S
Print Form , Worksheet for Combo Building & Solar Permit Application
Comm] j Residential City of Newport Beach - Building Division
17— NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
7Building r-Grading F-Drainage j-Elec (-Mech
Project Address (Not mailing address) C Flood
of Work
.21
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Cu Yd Fill
r Fire r" Liq r Landslide FN/A Floor
New/Add SFr lam' -2/ Remodel SFF— Garage/New/Add F
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OWNER'S NAME Last
F/T37Lbp ��2oUP L_ C First
Suite No
Use l i ConstType (/-$
# Stories # Units (if Res)rz
Valuation $
Material/Labor
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Owner's Address - -
Owner's E-mail Address
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City
-ZA Ar+ State
- - - - - % Telephone 7 / L f , _71? 1. 2-7� /
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APPLICANT'S NAME
Last
Applicant's Address
AID / W M A->:tl�2za fv 2 62 t�
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City S Z State [
First 17, / tM Crr l4 -
Applicant's E-mail Address
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ZiP j 7n4- Telephone ](ct j 3,_(, oa /
ARCHITECT/DESIGNER'S NAME Last
First F� Lic. No. F�
Architect/Designer's Address Architect/Designer's E-mail Address
City
State �— Zip F— Telephoner —
ENGINEER'S NAME Last L
- - - First �� Lic No.r--
Engineer's Address Engineer's E-mail Address
City State F Zip Telephoner —
CONTRACTOR'S NAME/COMPANY No. Lic. I
I C) 2`f �Classr3
Contractor's Address Contractor's E-mail Address
City S Z � State ! Z Zip la 7 X�zj TelephoneF �
SETBACKS REAR SETBACKS FRONT PERMIT N0, X 2 p Z O ��y
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. GE7-LoZZ
USE ZONE - nF\/m OMAPKiT Kin _.