HomeMy WebLinkAboutX2022-0783 - Permit ApplicationPrint Form_ I Work`s�heet for Combo Building & Solar Permit Application zEW�R,
j- Comm I 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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Valuation $
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New/Add SF � �'� Remodel SF •�— Garage/New/Add �—
OWNER'S NAME Last �L�c lLFirst1
Owner's Address Owners E-mail Address
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City � � { ��() /'1 �/` Stater Zip { Telephone[ —
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APPLICANT'S NAME Last' u�'� First
Applicant's Address Applicant's E-mail Address
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City ���'t(�t(P State Zip 7/ Telephone
ARCHITECT/DESIGNER'S NAME I
Last i`I-���.Y1 First �l f�`�I. Lic.No.F—
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Architect/Designers Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last {�� j ��t; First `�l�'� LicNo.
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Engineer's Address Engineer's E-mail Address i
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City WY��' ��/�� State /— Zip— Telephone�—
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CONTRACTOR'S NAME/COMPANY Lic. No. < Class
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Contractor's Address Contractor's E-mail Address
City -,1c - � ,- � State Zip a J�' Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. l
SETBACKS LEFT SETBACKS
RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ ;'-