HomeMy WebLinkAboutXR2023-3161 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
r comm" XResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work i 1
S1s�� Const Type F_
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# Storiesa # Units (if Res)FF
Valuation$
New/Add SF � w Remodel SF CQ Garage/New/Add.Material/Labor
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OWNER'S NAME Last 1%P,1,/./1144fro First
Owner's Address aI ^ LGG Owner's E-mail Address
City �J. 13(4 t, State Zip 7 � r.(� TelephoneF—
77
APPLICANT'S NAME Last a'S fiFirst
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Applicant's Address pplicant's E-mail Address
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City 'S// � �State � ZipFT,v 3
ARCHITECT/DESIGNER'S NAME Last First � Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F— Zip Telephone
ENGINEER'S NAME Last �— First F— Lic. No.F—
Engineer's Address Engineer's E-mail Address
City � State F_ Zip F Telephoned
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CONaRAoCs ORd eNAME/COMPANY {�.�%,� �octorE-mail
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City �./IrlO�.. State C� Zip / 4�Zf Telephone ?/ ( 96 r —d ,/%7
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ; I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $