HomeMy WebLinkAboutX2022-1669 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application COWr Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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# Stories #Units (if Res)
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Material/Lab
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Garage/New/Addy—
OWNER'S NAME Last / /CL��Y
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Owners Address
Owner's E-mail Address
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APPLICANT'S NAME Last G�if J L���
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Applicant's Address
Applicant E-mail Address
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Zip %,?6Z Telephone y49)���9/U
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City State F_
Zip F— TelephoneF—
ENGINEER'S NAME Last
First Lic. No.F_
Engineer's Address
Engineers E-mail Address
City State
Zip [ Telephoned
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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City CuST14 r�l %� State rl 7
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. n
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $