HomeMy WebLinkAboutH2022-0216 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ?EW�ae
F, Comm'I VResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [ Flood r- Fire [ Uci j- Lalllllndslide ❑N/A Floor Suite No
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Description of Work
Use �� ConstType
# Stories # Units (if Res)C
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Valuation S Fs
Material/Labori
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OWNER'S NAME Last I First I J lft
Owner's Address Owner's E-mail Address
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City cor.�n� t State �', Zip �2 C2S Telephone a tf j- 7- �Z31
APPLICANT'S NAME Last First pin ( Cr
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Applicant's Address Applicant's E-mail Address
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City Tn yi , r� State Zip k8u k Q - >2-SSA
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ARCHITECT/DESIGNER'S NAME Last �N/kit { _ First Nrya� Lic.No.�
Architect/Designees Address Architect/Designees E-mail Address
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City T,n.S•�- State `� Zip c127j�D Telephone qt{�- 07 - q7,>
ENGINEER'S NAME Last First Lic. No. ei in
Engineer's Address Engineer's E-mail Address
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City State r Zip F— Telephone q �F K " 3) �3 Z
CONTRACTOR'S NAME/COMPANY pnr�cn�Lt l3rc��e,s CDns (Lwc{,Y Lic.No. q0;S o ClassC
Contractor's Address Contractor's E-mail Address
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City �w5f State Grp Zip R�7�D Telephone ajq. 61.1_ s7t�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S