HomeMy WebLinkAboutXR2022-2164 - Permit Application_ __Print Form IWorksheet for Combo Building & Solar Permit Application �EWPoq,
F Comm1 - Residential City of Newport Beach - Building Division z �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work -
New/Add SF Remodel SF �—
71- __- FW2,��O Garage/New/Add -
OWNER'S NAME Last
Owner's Address
City I Vs21.nATn— _ .
APPLICANT'S NAME
Applicant's Address
City
First
Use Const Type Z&Z
# Stories # Units (if Res)L
Valuation $
Material/Labor
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Owner's E-mail Address
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State Ctl� 1.___ -_
- Zip _.j A('6 L Telephone
Last
First
Applicant's E-mail Address
State --
- - Zip �— TelephoneF� -
ARCHITECT/DESIGNER'S NAME
Last L First � �tj
Architect/Designer's Address - Lic. No. �S
Architect/Designer's E-mail Address
State �-
- Zip G% Telephone
NEER'S NAME Last
Firsts Lic No f�
En ineer'sAddress - ---
Engineer's E-mail Address
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City State -
Zip F Telephone
CONTRACTOR'S NAME/COMPANY ' nn
V r t.eS { l_ -_ G Lic. No. F— Class
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Contractor's Address
333Y .Caa Contractor's E-mail Address
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City State FM— Zip 66—
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT PERMIT NO.
SETBACKS RIGHT
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USE ZONE DEVELOPMENT NO PLAN CHECK NO.
PLAN CHECK FEES $