HomeMy WebLinkAboutX2022-1020 - Permit Application (3)Lj22-1 X20
Worksheet for Combo Building & Solar PeApplication
rl Comm'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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❑N/A Floor 1111 Suite No
7 177
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# StoriesF17 Units (if Res)
Valuation 5 1 51
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OWNER'S NAME Last I
First SUs
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last
Applicant's Address
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City State Cir
First Dolo
Applicant's E-mail Address
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Zip 97_zS73Telephone 741-57-44611`➢
ARCHITECT/DESIGNER'S NAME Last ►e�-�e First Jif Lic. No. 2 "� Yd-
Architect/Designer's Address
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Architect/Designees E-mail Address
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ENGINEER'S NAME Last First Lic. No.
Engineer's Address
City State F77
Engineer's E-mail Address
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CONTRACTORSNALic. No. IOS Z Z 38 j Class �3--
ME/COMPANY - -
Contractor's Address
City _ - State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
Zip F— Telephoned
PERMIT NO. x )ZZ '0740
PLAN CHECK NO. 0 G 3 i � ZC-Z
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