HomeMy WebLinkAboutXR2023-0668 - Permit Application1__PdntForm_Worksheet for Combo Building & Solar Permit Application
F_ Comm'I FV/ esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
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Project Address (Not mailing address) C Flood F_ Fire F_ Liq F_ Landslide CN/A Floor Suite No
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Description of Work
Use - Const Type -
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# Stories #Units (if Res)
Valuation$ [-52 ? 00
Material/Labor /
New/Add SF� Remodel SF-Garage/New/Add
OWNER'S NAME Last 011�irN1A/VA ,571'N 5 ZZ rpj�D /pgp
Owner's Address Owner's E-mail Address 9 %
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City rV(ICIX7 )?)Fjort} State F' " Zip �� Telephone
APPLICANT'S NAME Last 45;W First
Applicant's Address Applicant's E-mail Address
City State F Zip F-- Telephoner
ARCHITECT/DESIGNER'S NAME Last s//��s`��' ���r Lic. No. �—
Architect/Designer's Address Architect/Designees E-mail Address
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City - State 6_4 Zip qZ3/7 Telephone 3/0 �Z �1`fZO
ENGINEER'S NAME Last First Lic. No. ---
Engineer's Address Engineer's E-mail Address
City State Zip - Telephone[
CONTRACTOR'S NAME/COMPANYLic. No. 72 /5 /.S� ClassF
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Contractor's Address Contractor's E-mail Address
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City OS7 a/ State —, Zip z G_Zlo `/¢ CZ) Telephone %4 -3 70
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK No 7E 2Dt 'D jj
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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