HomeMy WebLinkAboutXC2022-1950 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I ❑Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,Building ❑Grading [],DrainageAIElec r1jMech Plum CurdCut � CuvdFill l
Project Address (Not mailing address) C Flood ❑Fire ❑ Llq Landslide (N/A Floor Suite No
Description of Work
-- Use Fr.,4 ConSTTvnp �n4
# Storied y I # Units (if ROE
New/Add SF Remodel SF Garage/New/Add �� Matedal/i.Valuation $ abor �a
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OWNER'S NAME Last " -f Ile l le/k /A..InI,—J-1 First II
Owner's Address Owner's E-mail Address
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City R✓ljd� � State ` TL �t� /i
Zipl `7Y,�-Telephone
APPLICANT'S NAME Last I \.ii 4M 1 First
Applicant's Address - Applicant's E-mail Address
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- ' �� 9 7
City (J(,(�j ( State C Zip Z (7 t Telephone -
ARCHITECT/DESIGNER'S NAME
Last �)\ v11;,(7 First �;�( I
ArchitecUDesignees Address
CihW State
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Lic. No. G._q Bl.�
Architect/Designer's E-mail Address
11
Zip
26.6 J Telephone qq- Co P
ENGINEER'S NAME Last First F 1 Lic. No. �
Engineer's Address
City ----------_-- i State C
Engineer's E-mail Address
Zip Telephoned
CONTRACTOR'S NAME/COMPANY — Lic No. 6 175501 Class
Contractor's Address
City Stater C--
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephone
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PERMIT NO.y
PLAN CHECK NO. -TcZoll-S3+
PLAN CHECK FEES $