HomeMy WebLinkAboutM2022-0035 - Permit ApplicationL Print Form J A n W1Z kshe � �sr Combo Building & Solar Permit Application
F Comm'I V Re/siid'enr-ia Z l� City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not Mailing address) f— Flood F_ Fire F_ Liq F_ Landslide f N/A Floor Suite No
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Description of Work
Use Const Type �—
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# Stories #Units (if Res)F
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OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
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City
State I v ` - Zip �7 4 Telephone--
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APPLICANT'S NAME
Last First
Applicant's Address
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L(6 � a1VV Q, Applicant's E-mail Address
City
State �— Zip F_ Telephone—
ARCHITECT/DESIGNER'S NAME Last First F Lic. �--
_ No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip Telephone) ---
ENGINEER'S NAME
Last `„ First � Lic. No.tz-
Engineer's Address
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Engineer's E-mail Address
City (,J'WC4. - State C�m ZiP 2 � Telephone
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CONTRACTOR'S NAME/COMPANY �� � Lic No. lo;/ 31 Class
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Contractor's Address
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Contractor's E-mail Address
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City 1v� i5
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State C�— zip Tell�phone F yf sio
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. %c�j
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. -'
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $