HomeMy WebLinkAboutX2022-0106 - Permit ApplicationX 2u22 -ft
Print Form " Wr eet for Combo Building & Solar Permit A licationn
City of Newport Beach - Building Division
F- Comm'I J? ,Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'S
OWNER'S NAME Las t�[i3 First \
Owner's Address Owners E-mail Address
City � � State �! Zip .._�� '�'�_ Telephone C utaV , iZ t
APPLICANTS NAME Last First
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Applicant's Address Applicant's E-mail Address
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City !) � \s - l State Zip Gj s - '', Telephone }()- Vh �p 1%
ARCHITECT/DESIGNER'S NAME Last First �' Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City �! State !! Zip— Telephoned
ENGINEER'S NAME Last Firsti Lic. No.F—!
Engineer's Address Engineer's E-mail Address
City State Zip i Telephoned
CONTRACTOR'S NAME/COMPANY r'� Lic. No.FO5 Class F9
Contractor's Address Contractor's E-mail Address
Cary t 1 �� (� \ . \� n State Zip OFL TelephoneU
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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