HomeMy WebLinkAboutXR2023-0758 - Permit ApplicationPrint Form ' Worksheet for Combo Building & Solar Permit A� ��W°�A'
F_ Comm'I Residential City of Newport Beach -Building Division TEA% Z3 (�y�� Q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI L
F-Building [Grading ainag - ec F_Mech rplum CuvdCut u
Project Address (Not mailing address) C Flood __ Fire Liq Landslide [N/A Floor Suite No
Description of Work e_ ' e- o
Use F- ConstType
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# Stories # Units (if Res)
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New/Add SF� _Remodel SF Garage/New/Add jMaterial/L�bor
luation $
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OWNER'S NAME Last First
Owwne(s Address
Owner's E-mail Address
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City C� T G� State Zip _(p�
Z� Telephone 81�
APPLICANT'S NAME Last '�-L First
Applicant's Address >e_c5 �( f Applicant's E-mail Address
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City t to Zip �� "3 Telephone `O 611-7SDL Ci/
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ARCHITECT/DESIGNER'S NAME Last First NA LG F� Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City ¢ State Zip Telephon
First � Lic. No.
ENGINEER'S NAME Last NA,
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Engineer's Address Engineer's E-mail Address
City State Zip Telephone�—
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
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Contractors Address vp
'/ Contractor's E-mail Address
City State F_ Zip F-- TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT N0. X`%iZt� _Q7S,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �G�t C] — 063
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