HomeMy WebLinkAboutXR2023-0529 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application �EW�ar
Comm'I J?'�'esidential City of Newport Beach - Building Division
/ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM'TTAi
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Project Address (Not mailing address) C Flood Fire F_ Liq r Landslide FN/A Floor Suite No
Description of Work
Use s Const Type
# Stories # Units (if Res) i
New/Add SF Remodel SFWD
Valuation $ �} /
arage/flew/Add �- Material/Labor 7L� (ivy
OWNER'SNAME Last �/� (� �
First i
Owner's Address
Owner's E-mail Address
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City F State r-- ZIP F— -
Telephone
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APPLICANT'S NAME Last 14/ur
First u q-
Applicant's ,Address
Applicant's E-mail Address
City State
Zip li um Telephone
ARCHITECT/DESIGNER'S NAME Last First 3V� (�— Lic. No. �-
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City State �—
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P 2�� Telephone Gj UA'
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ENGINEER'S NAME Last First
-M���J Lic. No.
Engineer's Address
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Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY � � Z �M Lic. No. Class pG (b
Contractor's (Address p y [
Contractor's E-mail Address
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Zip 12�J Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 4e, a
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO./%CG `f�jy7j 0�(%1
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $