HomeMy WebLinkAboutPV2022-161 - Permit ApplicationPrint Form, Worksheet for Combo Building & Solar Permit Application N
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Cit of Newport Beach - Building Division �� I 1 n f z _�
r' Comm'I r/ -Residential y p g 11r
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI TAL U5 -_.a
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Project Address (Not mailing address) r Flood rj Fire r Liq r Landslide [JN/A Floor Suite No
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,otf Work '1 / I ' I
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# Stories! # Units (if Res)
New/Add SF�-'i
Remodel SF �-
Garage/New/Add �-
luation
VaMaterial/Labor ✓5) 00C
OWNER'S NAME
Last
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� First
Owner's Address
Owner's E-mail Address
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Ci I -CA ZIPF""Telephone �Clcf Ck..�->Si[�j
APPLICANT'S NAME Last F S� First % n _Le
e
Applicant's Address-
n Applicant's E-mail Address
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City _ y State GA Zip qj Telephone _
ARCHITECT/DESIGNER'S NAME Last �—
FirstF Lic. _7777
- -
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephone
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ENGINEER'S NAME
Last I First Lic. No. �
Engineer's Address Engineer's E-mail Address
City - _ _ State Zip Telephone
CONTRACTOR'S NAME/COMPANY sOIG r {� Lic. No. 1033340 I Class �..10 !
Contractor's Address Contractor's E-mail Address
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City�.r State Zip Telephone
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SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USEZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $