HomeMy WebLinkAboutXR2023-2471 - Permit ApplicationPrinf Form Worksheet for Combo Building & Solar Permit Application 6"",
f60mm'I FCAesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r Flood r Fire F_ Liq r Landslide FN/A Floor Suite No
Description of Work Lt/,:-7-§�iL-- /Ali rWS/ew12 sr j�rzro idle
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OWNER'S NAME Last l ,h G�'/J �p First
Owner's Address Owner's E-mail Address
City e Zip F—Telephoned
APPLICANT'S NAME Last /�jL(>/9k First
Applicant's Address Applicant's
Applic/ant's E-mail Address
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City /- fIL%/ G /!5,L f N0 State Zip ' , Z Telephone W-2nt�—41;7i�l
ARCHITECT/DESIGNER'S NAME Last First X,tl A✓.d/ Lic. No. 2
Architect/Designer's Address Architect/Designer's E-mail Address
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City St, t ip Telephoned
ENGINEER'S NAME Last First F_ Lic. No.F--
Engineer's Address Engineers E-mail Address
City State F_ Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F_— Class F
Contractors Address Contractors E-mail Address
City State F_ Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. X a� — Z7 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (�GZJL3 ZI 6�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $