HomeMy WebLinkAboutXR2023-3495 - Permit ApplicationPrint Form II Worksheet for Combo Building & Solar Permit Application
V nesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood
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Description of Work �� /; ArHA
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Valuation $
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New/AddSFF e SF�!f Garage/New/Add F —
Material/Labor /K1/
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OWNER'S NAME Last �O First
Owner's Address
Owner's E-mail Address
City State F_
Zip F— Telephoned
APPLICANT'S NAME Last �� �7X
First l,
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Applicant's Address
Applicant's E-mail Address
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City4l%k /c<< State—
Zip / �i L Telephone % —
ARCHITECT/DESIGNER'S NAME Last A�. f/Z-j
First /1� Lic N Z
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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City
Telephone
ENGINEER'S NAME Last
First F_ Lic. Nof—
Engineer's Address
Engineers E-mail Address
City � State
Zip �� Telephoned —
CONTRACTOR'S NAMECOMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State
Zip �` Telephoner
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SETBACKS RIGHT
ZONE DEVELOPMENT NO
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PLAN CHECK N
PLAN CHECK FEES