HomeMy WebLinkAboutXR2023-0074 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application ROOMr Comml j Residential City of Newport Beach - Building Division
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Project Address (Not mailing address) I- Flood F— Fire I— Liq r Landslide I —N/A Floor Suite No
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Description of Work
Use ConstType
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# StoriesF # Units (if Res)F—
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Valuation $
Material/Labor
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OWNER'S NAME Last S—OG ��;) �ry p First
Owner's Address
E-mail Address
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APPLICANT'S NAME Last 'T. c- R _ , C� First
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State F Zip �— TelephoneFa
ENGINEER'S NAME Last First F_ Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY r`� Lic. No. 7(U-f�+ ClassY
Contractor's Address Contractor's E-mail Address
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City State C T Zip Cl Z 4 4 Telephone t `(—
SETBACKSREAR SETBACKS FRONT PERMITNO.(/�T/%
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �G ZpZZj' OwZi
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $