HomeMy WebLinkAboutX2022-0644 - Permit Application� 9 -0`L7 --O U L4 4
Worksheet for Combo Building $ Solar Permit Application
❑ Comm'I Hyl Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Address
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Description of Work
(AIaU, B)OCA V-4 �i�qS jets
New/Add SFF Remodel SF [777777 Garage/New/Add [- I
OWNER'S NAME Last
Owner's Address
First
Owner's E-mail Address
Suite No
Use 17 Const Type
# Stories; # Units (if Res)n
Valuation $ %
Material/Labor - `-���000 —
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City /;;PeC State -CIQ -- Zip q'26�7_ Telephone1 7_2RI
APPLICANT'S NAME Last �II First
Applicant's Address Applicant's E-mail Address
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City -� fjCC)v q �� / /�ar State I `'A ZiP Io-6� J Telephone ilg-,S-;I-36S(- I
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect(Designer's Address Architect/Designer's E-mail Address
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City State �I Zip Telephone
ENGINEER'S NAME Last,,, -I_ First Lic. No. g(8p5
Engineer's Address Engineer's Eg-mail Address
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City State Zip Telephone
CONTRACTOR'S NAME/COMPANY p a �ui - - -- -- - -- Lic. No. j} � L� ClassFF
Contractor's Address Contractor's E-mail Address
CState
city Zip !Telephone[-
SETBACKS
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X Z02 -Z "064q
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 0 S 82 - 2j) 7-