HomeMy WebLinkAboutXR2022-2312 - Permit ApplicationL Print Form j Worksheet for Combo Building & Solar Permit Application Q.
F_ Comm'I r✓Residential City of Newport Beach - Building Division ` �
NOTE: PLAN CHECK FEES DUE AT TIME OF SI IRMITTAI
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Project Address (Not rnailing address) I- Flood i- Fire r7 Liq F- Landslide I -N/A Floor— Suite No
Description of Work
Use ConstTyple
# StoriesF # Units (if Res)F
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OWNER'S NAME Last ( rF First
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last �/{C First �fl /G i p
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last S First /�—
Architect/Designer's Address Architect/Designer's E-mail Address
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ENGINEER'S NAMELast F v(JL l� � First /rJ
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Engineer's Address Engineer's E-mail Address
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City LN( r- State Zip F C(ZC Telephone
CONTRACTOR'S NAME/COMPANY //�l ! / Lic. No. � D J `?
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. J�`I`� )(tV,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (76 ZCfZ;Z -ZIs3
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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