HomeMy WebLinkAboutXR2022-2177 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r.- Flood Fire [_ Liq I— Landslide f N/A Floor
Description of Work
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OWNER'S NAME
Last r -' l , First 1���L `t `'
Owner's Address
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Suite
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Use Const Type V yl
# Stories[ # Units (if Res)
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Valuation $ 0,0
Material/Labor
Owner's E-mail Address
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APPLICANT'S NAME Last L ' First
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Applicant's Address
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Applicant's E-mail Address
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Zip . Telephone .- {j6
ARCHITECT/DESIGNER'S NAME Last FirstFbe Lic. No.
Architect/Designees Address
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Architect/Designees E-mail Address
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First
ENGINEER'S NAME Last C(tvlCt
En_gineer's Address h
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State
City
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Engineer's E-mail Address
Zip 2S 2 Telephone r{p ?J +(a
CONTRACTOR'S NAME/COMPANY Lic. No.Class
Contractor's Address
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Contractor's E-mail Address
Zip Telephony[; �20//_A/Jo
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO. n !
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $