HomeMy WebLinkAboutXR2023-1918 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 04)141t`F_Comm] i— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) i- Flood i- Fire r Liq r Landslide (-N/A Floor Suite No
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Description of Work
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Valuatio 0
Material/Labor
New/Add SFr— Remodel SF F— Garage/New/Add F_
OWNER'S NAME Last Li v First J\0.✓-)
Owner's Address Owner's E-mail Address
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City NZ40"t h State COY Zip °1)_6Telephone Gab-
APPLICANT'S NAME Last kjj'.-W,First Mpf)�_
Applicant's Address Applicant's E-mail Address
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City N ,Y�. 6V-\ State i CIA Zip � 6 I Telephone '7 g ) - _2.>30
ARCHITECT/DESIGNER'S NAME Last �— First Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F_ Zip F_ Telephoner
ENGINEER'S NAME Last First F Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY E/J� Lic No. F Class
Contractor's Address Contractor's E-mail Address
City �— -- State Zip I wo;v Telephoner a
SETBACKS REAR SETBACKS FRONT PERMIT NO. x K.? Q a3 - (1 r 8
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $