HomeMy WebLinkAboutXR2023-0780 - Permit ApplicationPrint Form_ j Worksheet for Combo Building & Solar Permit Application
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) C Flood r Fire [7 Liq r Landslide FN/A Floor Suite No
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Description of Work
Use Sfx—ConstType F�9
# Stories # Units (if Res)
Valuation $
Material/Labor
New/Add SFF Remodel 5F [rbpff Garage/New/AddF_
OWNER'S NAME Last Q First
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Owners Address - - - Owner's E-mail Address
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City -1N ctTj-fit State — Zip �Zbf� u TelePhone �lu3y-"��
APPLICANT'S NAME Last — First
Applicant's Address Applicant's E-mail Address
City State Zip — Telephone7
��`�� Last Lt/V\ .First - `_ Lic.No. -2—
Architect/Designees Address Architect/Designer's E-mail Address
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City 5�A State Zip 1`Z S I Telephone -iyct 3_
Last First 7— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. j los i Z�Class
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Contractor's Address Contractor's E-mail Address
City !�q J N-`' State �G Zip Telephone `?jjp-��_��
SETBACKS REAR SETBACKS FRONT PERMIT NO. �Z�%' O
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, J &Z,00,72 CQ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $