HomeMy WebLinkAboutXR2023-1400 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oa��T°JR>e
F- Comm'I esidential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood
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Description of Work
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# Storiesl/�d/ I*Units (if Res)
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Valuation $
New/Add SFF— Remodel SFF Garage/New/Add
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Material/Labr
OWNER'S NAME Last(' S First
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Owner's Address
Owner's E-mail Address
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City po ._ State Cck
Zip � 5 Telephone — — X
APPLICANT'S NAME Last I/7/�"� )
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First �a (/I&
Applicant's Address
Applicant's E-mail Address
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City S M,e5o. State C�
Zip Telephone �� y 3 ,�914V
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineers Address
Engineer's E-mail Address
City State F_
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
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Co cto s�Ad�d/ress
Contractorrs E-mail Address
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City C( .� (L WS- State C�
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Zip q,% Telephone 713 50' 091 y
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SETBACKS REARV SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $