HomeMy WebLinkAboutXR2023-0540 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application �E °�
Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X R tl l)% 3_ ntzu fl u�` ,
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Project Address (Not mailing address) C Flood F- Fire FAALiiq F- Landslide [N/A Floor Suite No
Description of Work
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Valuation $
Material/Labor Z WG
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New/Add SFe( Remo��deh�SF"" Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City VVt �� (/ State Ca. Zip Telephone 77 �'// +1
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City F State �— Zip �— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last First I Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
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City State F— Zip e Telephone
ENGINEER'S NAME „Last 6G(a „ l First -A� Lic. No. P ( 9—
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Engineer's Address Engineer's E-mail Address
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City ,eCL t . State Zip F Telephone
CONTRACTOR'S NAME/COMPANY Lic. NoT— Classe
Contractor's Address Contractor's E-mail Address
City State F— Zip I Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. L}t �'
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USE ZONE DEVELOPMENT NO Q ZF3L ( - [��ZI PLAN CHECK FEES $