HomeMy WebLinkAboutXR2022-2446 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application o69-Re
j Comm'I(Residential City of Newport Beach - Building Division
r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood
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Description of Work 'N i
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Use _ ConstType v_ l>
Stories # Units (if Res)T
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Valuation $
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New/Add SF Z/ Remodel SF L Garage/New/Add
Material/Labor .,'�
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OWNER'S NAME Last ILI Orx�,TG
First , 1 It AIK_ea s
Owners Address
Owner's E-mail Address
city I `�`' j?j�& State Imo'=
Zip 9' y(�-0 Telephone q-
APPLICANT'S NAME Last S�-i`UIcN��
First `
Applicant's Address
Applicants E-mail Address
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City c�"�` State �(
Zip 41, - Z7 Telephone
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First �— Lic. No.
ARCHITECTIDESIGNER� ME Last L�� I
Architect/Designers Address
Architect/Designers E-mail Address
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city 1k rlet5k_ State
Zip 'T 2-1 Telephone[�,��.L, �
ENGINEER'S NAME Last Y� of--
First FQ(?t cAr Lic. No.F7_
Engineer's Address
Engineer's E-mail Address
City 51�. •�,q y,� State F(�
Zip 91:1 01r Telephone 'j. 0
CONTRACTOR'S NAME/COMPANY
Lic No.F Class
Contractor's Address
Contractor's E-mail Address
City State
Zip Telephoner
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
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PERMIT NO.
PLAN CHECK NO. Wky
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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