HomeMy WebLinkAboutXR2022-3277 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
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NOTE: PLAN CHECK FFF=C nl F: AT Tmn❑ nv ci 1❑nnrr7n1 vv> '1 h� i - L'1�,�
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Fpuilding F_ Grading F-Drainage r- Elec r Mech F- Plum CuYdCut CuYdFill
Project Address (Not mailing address) F_ Flood r" Fire I- Liq r Landslide F_N/A Floor Suite No
Description of Work �// - /fir %J!//GL7 %z jZ7L 1i iJO
Use �' UConstType ✓'
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/17L�,� �Y '9t,ydL.ce
# Stories # Units (if Res) 27
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/ -r/ `� id//JGL> A .u� c ��' � i/L,G . l'•t'Si,C : A1� /�'f- i
All
New/Add SF �- �gemodel SF / � Sf Garage/New/Add �—
Valuation
Material/Labor
OWNER'S NAME Last '�� jr jai ( First
Owner's Address _
Owner's E-m '
City State �— Zip F Telephones —
APPLICANT'S NAME Last F% �Z G First q \i
Applicant's Address
Applicant's EE--mail Address
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City reA rs`A ZIDState I 7 A Zip 2/ L Telephone Cf`i�Y
ARCHITECT/DESIGNER'S NAME
Last 17z4/1/,_/Zl First 7'
�,��y Lic. N ' q7 Z;' S-
Architect/Designees Address Architect/Designer's E-mail Address
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City _— . —State' Zip F Telephones--
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State Zip [— Telephones --
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F Zip -- Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. AT- 1/2--U-P
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. '�ULvZ2 31rs
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $