HomeMy WebLinkAboutXC2022-2109 - Permit ApplicationPrintForm_ Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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lescription of Work
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Owner's Address
City
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I Suite No
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Use I ConstType F—
# StoriesF_# Units (if Res)[
Valuation $ •,Q_
Material/Labor F10,ODO
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State F
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APPLICANT'S NAME Last All I A Aj
Applicant's Address
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City N , State C' Q
ARCHITECT/DESIGNER'S NAME
Last Architect/Designer's Address
City State �—
First I. NIF --%AA .A ti
Applicant's E-mail Address
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LiC. No.
Architect/Designer's E-mail Address
Zip �— Telephoned
First
ENGINEER'S NAME Last r�
�t v �i 5 First e #e Lic. No. C ld� 75
Engineer's Address J
Engineer's E-mail Address
City l�=
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State Zip ---------- — Telephone
CONTRACTOR'S NAME/COMPANY _
G4c Lic No. /D7`7Class CContractor's Address ��Contractor's E-mail Address
CityState
F Zip F—Telephone 7/�-EGG
SETBACKS REAR SETBACKS FRONT PERMIT NO. k 10?,Z• Zoo
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N
USE ZONE 0. pC
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