HomeMy WebLinkAboutXC2023-0319 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application
❑ Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FFFS nt IF AT TIME nF SI IR&AITTAI
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Project Address
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Description of Work
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ConstType p
I ` I # Stories I # Units (if Res)
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Valuation $
New/Add SF�--!, Remodel SF -[ Garage/New/Add MateriaULabor 1 J i'�'
OWNER'S NAME Last First
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Owner's Address
Owner's E-mail Address
City Sate —I Zip —Telephone �JU --
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City State Zip
Telephone_
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ARCHITECT/DESIGNER'S NAME Last
----- --First - -Lic. No.----
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ArchitecUDesigner's Address Architect/Designer's E-mail Address
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City ` i%WG��_ 9k .I State (r i zip 2 i)I Telephone CI 1. Cp�j i C1� z
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ENGINEER'S NAME Last First F77777—I Lic. No.F—I
Engineer's Address Engineer's E-mail Address
City State Zip �i�, TelephonedI
CONTRACTOR'S NAME/COMPANY I 0 13t1. ` r1rpf-M) tv Lic No. � Class
Contractor's Address f II Contractors E-mail Address
City State 7 , Zip � Telephone
SETBACKS REAR SETBACKS FRONT - PERMIT NO. XIC2023 • V31111
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO WUJ�Mj
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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