HomeMy WebLinkAboutXR2022-2614 - Permit ApplicationPrint Form _ j Worksheet for Combo Building & Solar Permit Application Rr
Comm I j_ Residential City of Newport Beach - Building Division p U.` 2
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBAALT-zL' IS
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Project Address (Not mailing address) r Flood r• Fire i— Liq f— Lan side [N/A Floor Suite No
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Description of Work
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C� y'�1r� j � � � ,mil•' ' i I n
• # St ories Units (if Res)
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'New/Add Remodel SF Valuation $
L__. ^{ ._ '._ �� Garage/New/A d i Material/Labor
OWNER'S NAME last c First
Owners Address y,� 1 3 iz 9 c-y�/- -o
Owner's E-mail Address U
City i ' . State ZIPTele hone
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.APPLICANT'S NAME Last First `
Applicant's Address Applicant's E-mail Address
City State �- Zip / Telephoner ,
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ARCHITECT/DESIGNER'S NAME Last -,' - - First
J r Lic. No.
Architect/Designer's Address. _ Architect/Designer's E-mail Address
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City State �— Zip[ —Telephoned_
ENGINEER'S NAME Last First r' Lic. No.
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Engineer's Addr s . _ Engineer's E-mail Address
City State }": ZipFT Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. P g gAgA ClassI 0
Contractor's Address Contractor's E-mail Address t C Cd•
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City WS7 A State 2 Telephone (7 rL� g>�� " ri 3 0
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X EL72,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �GZ0ti2 2�� 5
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $