HomeMy WebLinkAboutXR2023-0773 - Permit ApplicationPriht Form Worksheet for Combo Building & Solar Permit Application °
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City of Newport Beach- Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i
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Project Address (Not mailing address) [ Flood F_ Fire C Liq r Landslide E_N/A Floor Suite No
Description of Work
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New/Add SFF Remodel SF�— Garage/New/Add �—
OWNER'S NAME Last
Owner's Address
City (� 0 State C
APPLICANT'S NAME Last
Applicant's Address
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First
Owner's E-mail Address
Zip
Use ConstType
# StoriesF # Units (if Res)F7
Valuation $
Material/Labor
First I,
Applicanfs E-mail Address
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ARCHITECT/DESIGNER'S NAME Last I— First F_ Lic. No. �—
Architect/Designees Address
City State
Architect/Designer's E-mail Address
Zip _ Telephoned—�
ENGINEER'S NAME Last First
Lic. No.� —
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY, a �1$« Lic. No. 10( 601 2 Class
Contractor's Address Contractor's E-mail Address
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city F� 35 f �.� v ; � State Zip ZZ' q ( Telephone 9y 4
SETBACKS REAR SETBACKS FRONT PERMIT NO. ?PffLZ&0?3_ 0773
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NPCZi►Z3_ Q6�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $