HomeMy WebLinkAboutXR2022-2944 - Permit ApplicationP,rint Form
L Worksheet for Combo Building & Solar Permit 'Application
V1160mm] Ft-l�e`sidential City of Newport Beach - Building Division �VDU_'Zalq
NOTE: PLAN CHECK FEES DUE AT TImF nF.ql JRNA Al (�_5�
t7-Building F7 Grading F—Drainage F_ Elec F_ Mech F plum Cu Yd Cut F_ Cu Yd Fill
Project Address (Not mailing address) f— Flood [_ Fire Liq F_ Landslide F_N/A Floor Suite No
Description of Work 11V 16- Z-�? /L__ Z_ 4w, 4 I-z
Us Const Type F7
# Stories rfl # Units (if Res)
o—
SF[ Re SAGarage/New/Add
Valuation $New/Add
Material/Labor 0)4
OWNER'S NAME Last 1AZtIlAIE First
...... . . ...
Owner's Address
_.Qwner-'sE,--ff6ff Address
1 City State
7 Zip Telephone F
APPLICANT'S NAME Last First
Applicant's Address /
Applicant's E-mail Address
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A
C�617A cll�Ttc
City IR q
,
Zee,7A AlLj State zip Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No
Architect/Designer's Address Arch itect/Designer's E-mail Address
y Stai�e 7—
cit77-
F Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip F Telephone
F
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip F_ Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,