HomeMy WebLinkAboutX2022-0023 - Permit ApplicationPnnt Farm Worksheet for Combo Building & Solar PeIr t�Ap Ii'ca`tivo
r— Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
4 uilding I -Grading F -Drainage r—Elec rMech rPlum cuvdcut cuvdFill
Project Address (Not mailing address) F_. Flood F- Fire F- Liq r Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
Stories # Units (if Res)
I#
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Material/Labor V�
Valuation$[_
New/AddSFF Remodel'SFF—
Garage/New/Add —'
OWNER'S NAME Last l (Iri�
First
Owner's Address
Owner's E-mail Address
City — -- — StateZip Telephone(�'—"J I! 4 y
APPLICANTS NAME Last (t1 f "
First��
Applicant's Address
Applicants E -m it Address
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City State
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7
Zi j^ Telephone
ARCHITECT/DESIGNER'S NAME Last 2
First = / _Lic. N .
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephone—
ENGINEER'S NAME Last b °
First VJ Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
.
CONTRACTOR'S NAME/COMPANY 1 44W
Lic.NO. Ac� (i�� Class
Contractors Address
Contractor's E-mail Address
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City ^'F!- State
Zip ef Telephone / ,4(jo —(
SETBACKS REAR SETBACKS FRONT PERMIT NO. ' LZ LZ -62
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.