HomeMy WebLinkAboutX2022-0839 - Permit Application_MM
Print Form Worksheet for Combo Building & Solar Permit Application orEW�Ra
omm'I r Residential City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing
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Description of Work
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Valuation $
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OWNER'S NAME Last I P7 t,r'DU'� First C"ZI -f f
Owner's Address
Owner's E-mail Address
Nom -
City _
State F Zip F -- Telephoned—.
APPLICANT'S NAME Last
'.. First
Applicant's Address
Applicant's E-mail Address
City I lutg" -"V
State I CVV Zip Telephone , dy5�r_-_jr 00 xlFa.
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ARCHITECT/DESIGNER'S NAME Last
First F Lic No. F_
_
Architect/Designer's Address
Architect/Designer's E-mail Address
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City IN6.r"J9WL.1 P,+70
State F_6� Zip y b6U. Telephone _(f _ s '_?1D U )
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ENGINEER'S NAME Last
First r------ Lic No.F -_—
Engineer's Address
Engineer's E-mail Address
City _
State F—.--- Zip Telephoned ---
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
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Contractor's Address
lnt t s E-mail Ad ess il
City _ _ _..
State !' *Wnl
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $