HomeMy WebLinkAboutX2022-1691 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application OSWComm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F-Grading F-'Drainage F-Elec F-Mech j`plum CuvdCucCu Yd Fill
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Project Address (Not mailing address) F7 Flood F- Fire r-_ Liq F- Landslide F N/A Floor F Suite No—
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F
Description of Work
Use F—Const Type
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# StoriesF_ # Units (if Res)
New/Add SF�— Remodel SIF Valuation $
/CC> Garage/New/Add �— Material/Labor
OWNER'S NAME Last
Owner's Address FirstJCc� jHn1CJ r1
..._-.-_. .
Owner's E-mail Address
City /Jc i �- -
_ tcr} _ 13C .. State C q
--- - - ZiP i zc. Tele hone
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APPLICANT'S NAME /
Lastuay�I<cS First l y�
Applicant's Address -
yApplicant's E-mail Address
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City s
---
CoS{w w,r<2 State ,=F, Zip )1t�,z, Telephone
ARCHITECT/DESIGNER'S NAME
Last %�rCd,p;
First J-a $-� V Lic. No. F—
ArchitecUDesigner's Address -
Architect/Designer's E-mail Address
-- city State C -1 Zip °lZce� Telephone
ENGINEER'S NAME Last
First F® Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY !> t'
Lic. No. � of I j z Class i
Contractor's Address
q 0�
Contractor's E-mail Address
l � � 12+h _ S F
J. lCq e y;w� .ti
City CO vN State I
C a ZIP FQj zc, z -7 Telephone iK S . W i � - i!� 2ci
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PI ARI rwory C,c m -�:�J