HomeMy WebLinkAboutXR2023-3226 - Permit Application (3)Print Form_ Worksheet for Combo Building & Solar Permit AppHeatlon rW�q
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City of Newport Beach - BuildingDivision Comm'I Residential. NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL T'
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Description of Work
7 Use F Const Type F
# Stories[ # Units (if Res)F—
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OWNER'S NAME Last ;,5 %lCvC' First 1%114V/ 5
Owner's Address
Owner's E-mail Address
City IL; State ' FF _ _ -
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APPLICANT'S NAME Last JrT c`; First
Applicant's Address Applicant's E-mail Address
City State �— Zlp F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last
F. z�.^-' First % �_,' Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City Jar-�: c. t State Zip TelephoneF2( 4% /
ENGINEER'S NAME Last Y5 G First ,5r c .ter Lic. Nof�
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY j:T (L), -1
Lic. No. 7z —Class
Contractor's Contractor's Address .. �/ Contractor's E-mail Address
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City c-�,,�,= State r � ZIP /7G i Telephone �/ �/�i �f
SETBACKS REAR SETBACKS FRONT PERMIT NO. �VZ 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $