HomeMy WebLinkAboutXR2023-1733 - Permit Application—/Print Form_ Worksheet for Combo Building & Solar Permit Application oQ�
IV `omm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF nF Sl IRKAITTAI
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Project A dress (Not mailing address) F Flood r- Fire r Liq r Landslide I —N/A Floor Suite No
Description of Work 6UA LDS Zf n o,�
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# StoriesFT # Units (if Res)j
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Valuation $
Material/Labor
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New/Add SFF— SF 71 SF Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Addres
City late Zip F_ Telephoned
APPLICANT'S NAME Last 7��G:q>e First );i1�
Applicant's Address
Applicant's E-mail Address
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L eA G- AA,,D State �ja ZipF? Z Telephone
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ARCHITECT/DESIGNER'S NAME Last GAA/ z. First ,9
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Architect/Designer's Address Architect/Designees E-mail Address
City Zip TelephoneF—
ENGINEER'S NAME Last First Lic. No.r—
Engineer's Address Engineers E-mail Address
City State �— Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY !J Lic. No. %of ?76 Class
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Contractor's Address Contractor's E-mail Address
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City State �— Zip TelephoneF
SETBACKS REAR SETBACKS FRONT PERMIT NO. 12ZflL-5 - II "1,1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $