HomeMy WebLinkAboutXC2022-1963 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
I Comm1 ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq � Landslide [�/A Floor Suite No
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Description of Work Use onstType �N
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It Storied / i If Units (if Res)
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New/Add SF Remodel SF 3 Gars e/New/Add
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OWNER'S NAME Last �r.{p,2a,�y/ Fret
Owners Address Owner's E-mail Address
City '�n/� __ I State Zip Telephone U
APPLICANTLast
S NAME Applicant's Address ttt
Applicant's E-mail Address
City--- State t Zip Z0(Zj Telephone Z _—�� yp
ARCHITECT/DESIGNER'S NAME Last First Q I(_ Lic No.
Architect/Designer'sAddress II-- Architect/Designees tE-mail Address t
cityL State �(/ � Zip 2b6 01 Telephone Cp IP e -4
ENGINEER'S NAME Last First Llc
Engineers Address Engineers E-mail Address
City State i Zip , Telephone I
CONTRACTOR'S NAME/COMPANY G yyR - P Lic. No. Class
Contractors Address �. � � CLontrdctors mail Address
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City State Zip I l Telephone -¢- � - C
SETBACKS REAR SETBACKS FRONT PERMIT NO. XG ZoZ2 • l ro3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $