HomeMy WebLinkAboutXR2022-2106 - Permit ApplicationPrint Form Worksheet for Combo Building $ Solar Permit Application
Comm'[ Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTECL V i
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Project Address (Not mailing address) C' Flood [ Fire [ Liq [ Landslide Floor Suite No
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New/Add SF — SY Remodel SF _ L L Garage/New/Add Material/Labor Cox
OWNER'S
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Owner's Address Owner's E-mail Address
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City I QCHjjti1 (7[ ( State Fol Zip q-1&&o Telephone
APPLICANTS NAME Last F�tLc-_
Applicant's Address
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City I L 6WI A !- Li.) State C;
First
Applicant's E-mail Address
Zip 7 ZC,^) Telephone
ARCHITECT/DESIGNER'S NAME Last I f3l1LLV_ First F13 iLli) Lic. No.
Architect/Designees Address
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Architect/Designees E-mail Address
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ENGINEER'S NAME Last �j�(t First Lic. No. Scx S7&
Engineer's Address
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City NA State cA
Engineer's E-mail Address
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Zip 7,rZ& 37 Telephone yyq - y&-3
CONTRACTOR'S NAME/COMPANY Cl _S �.6n Lic. No. (Class
Contractor's Address
City / State
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SETBACKS LEFT
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SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
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PERMIT NO.
PLAN CHECK NO. Z f•
PLAN CHECK FEES S