HomeMy WebLinkAboutXR2023-1415 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (N�0
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omm'I r 1[Yesidential City of Newport Beach - Building Division NOTE, PLAN CHFCK FFFS nI IF AT TIMr
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Project Address (Not mailing address) r Flood i— Fire r Liq r Landslide FN/A Floor Suite No
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Valuation $ pp
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OWNER'S NAME Last I 71f 1112—rl ll ro First
Owner's Address Owner's E-mail Address
City
Zip F_TelephoneF_
APPLICANT'S NAME Last First I c_�Ay
Applicant's Address
Applicant's E-mail Address
City State F--(7/1 Zip /�� Z_ Telephone : q�y
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ARCHITECT/DESIGNER'S NAME Last /ZA/fj/�r % First yzA
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Architect/Designer's Address Architect/Designer's E-mail Address
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City — _ Zip �— Telephone[
ENGINEER'S NAME Last First �— Lic. No.F
Engineer's Address Engineer's E-mail Address
City State �— Zip - Telephone[
CONTRACTOR'S NAME/COMPANY Z Lic. No. =�_� O /� Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.Gf��7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $