HomeMy WebLinkAboutXR2022-2911 - Permit ApplicationnntForm
'_EI - IiV'orksheet for Combo Btaiiding &Solar Permii Appiicatioro (N-B
F Comm'I FV/Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFF.c ni IF aT TIR= nr oI I�..I,
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Project Address (Not mailing address) [ Flood r Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type P. V-\
# Stories # Units (if Res)T
Remodel SF Valuation $
New/Add SF
� �— Garage/New/Add �— Material/Labor Isr 0
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OWNER'S NAME Last First �(C
Owner's Address Owner's E-mail Address
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City - - - _
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APPLICANT'S NAME Last
San i� First �G4 J
Applicant's Address Applicant's E-mail Address
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G� Co r+1c,�.i-o ate 02�f
City ¢Z� b `% P (44_9) 75� 94 f
State GA Zip Tele hone
ARCHITECT/DESIGNER'S NAME Last
_ _ First— Lic No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zi
�— Telephone—
ENGINEER'S NAME Last First
�r-r_Kz _ _ - _ _ _ i-,e 0 _ Lic. No.
Engineer's Address Engineer's E-mail Address
City ij,na Pp a - State G A_ Zip Telephone
(945) 2S7-`7662.
CONTRACTOR'S NAME/COMPANY
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Contractors Address 9353-7 Z
!� Contractor's E-mail Address
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City State CO Zip $; 3j Telephone �`}u9�iSa 4511
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $