HomeMy WebLinkAboutXR2022-3161 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Q
City of Newport Beach - Building DivisionComm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL XR�Q�'
(-Building r Grading r-Drainage r Elec r Mech r Plum Cuvdcuf CuvdHI F
Project Address (Not mailing address) r Flood r Fire r Liq (— Landslide FN/A Floor Suite No
Description of Work
Use F—ConstType F
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# StoriesF_ # Units (if Res)
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Valuation $
New/Add SF ` �.:r , Remodel SF Garage/New/Add
Material/Labor
OWNER'S NAME Last l ,i .{ Firsts '' r
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Owner's Address Owner's E-mail Address
City f776 i!vr\ State(W Zip -)'),� c� Telephone --7I I lv 74
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APPLICANT'S NAME Last ly, First f
Applicant's Address Applicant's E-mail Address
City 11� �J� i �'.. �,' State r Zip Telephone
ARCHITECT/DESIGNER'S NAME Last �— First Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
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City I State F Zip F® Telephoned
ENGINEER'S NAME Last First F_ Lic No.F
Engineers Address Engineer's E-mail Address
City State F Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY T Lic. No. f Class (5 i
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Contractor's Address Contractors E-mail Address
City �, i. � ur:� '6 dw t State I Zip s Telephone /
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X ky2/ 2 ,- 1toi
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO'9f,O I C1 • 0 V) ` }D PLAN CHECK FEES $