HomeMy WebLinkAboutX2022-0220 - Permit ApplicationF!r(nt Form;. I Worksheet for Combo Building $ Solar Permit Application
F-1 Comm'I IV,,Residential City of Newport Beach -Building Division x202'1, -Q 2`O
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r_7 Grading Drainage ❑ Elec [7 Mech [- Plum curd cut cued Fin L
Project Address (Not mailing address) CI Flood ❑ Fire (-I Liq F -j La llndslide ❑N/A Floor Suite No
Description of Work
Penovt✓ eK16,h • a It I w 2 t1 �tJ
New/Add SF Remodel SF F— Garage/New/Add—I
OWNER'S NAME Last Iheainef5 EOMMUn17Y Firstr
Use n Const Type FI
# Stories # Units (if Res)n
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Owner's Address 77 Owner's E-mail Address
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City State F 6F
Zip Telephone N71 4S " IZa�
APPLICANTS NAME Last First a✓N S
Applicant's Address
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City �iV\�e State L "CC.._...I
Applicant's E-mail Address
�vla �Gtns Z G C r( C�v�t
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Zip q va t %7 Telephone�/k�j-�UZ_Cl74
ARCHITECT/DESIGNER'S NAME Last �— First F Lic. No. F I
ArchitecttDesigner's Address
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city —i State 77
ENGINEER'S NAME
Architect/Designees E-mail Address
Zip [_ Telephoner
Last --- - -- - First
Engineer's Address
City Xn�7Lt_9�ta ' ft ie, j State
Lic. No. p_I
Engineer's E-mail Address —
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Zip Telephone�N�
CONTRACTOR'S NAME/COMPANY ��� I2L ! Lic. No. Class
Contractor's Address Contractors E-mail Address
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City kfoil C ---- _-- State L I Zip ��tt� Telephone �(Q�7 �UZ-�I (�
SETBACKS REAR SETBACKS FRONT PERMIT NO. `vV
SETBACKS LEFT SETBACKS RIGHT ` PLAN CHECK NO. t
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