HomeMy WebLinkAboutXR2023-0344 - Permit ApplicationWorksheet for Combo Building & Solar Permit APP9i,cation
;ai City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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OWNER'S NAME Last f,`, „ , First
Owner's Address Owner's E-mail Address
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Cit �w � — '' State �— Zip Z�� Telephone �I i �G 0��'�
APPLICANT'S NAME Last I A .fir K-S
Applicant's Address
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City
ARCHITECT/DESIGNER'S NAME
Last
State L f,
Architect/Designer's Address
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City — S�
ENGINEER'S NAME Last IA,
Engineer's Address
City I 11
CONTRACTOR'S NAMEICOMPANY
Contractor's Address
First
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Applicant's E-mail Address
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i7 Telephone F i
First
Architect/Designees E-mail Address
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Lic. No. � —
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C A Zip Telephone (919 ) 5r. 3 ( 9 (91-"
Lic. No. F— Class
Contractor's E-mail Address
City �---- Ste Zip I-- Telephoned__
SETBACKS REAR SETBACINT
PERMIT NO. Ar 5OV,7 - 0_14A
SETBACKS LEFT SETBACKT
PLAN CHECK NO.
USE ZONE DEVELOPlO PLAN CHECK FEES $