HomeMy WebLinkAboutXR2023-2711 - Permit Application- Print Form Worksheet for Combo Building & Solar Per t Application
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City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM Z,-'
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Project Address (Not mailing address) - Flood [_ Fire r' Liq r- Landslide rN/A Floor Suite No
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Description of Work
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Valuation
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Materil/Laborr
New/Add Remodel SFbLGarage/New/Addr
OWNER'S NAME Last bQ i First �a
Owner's Address Owner's E-mail Address
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City I I� �yJ pa(}-� C I {� State C t"� Zip L.Cf Telephone
APPLICANT'S NAME Last '' .. ``
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Applirant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
ArchitectlDesigner's Address Architect/Designer's E-mail Address
City State F— Zip I TelephoneF
ENGINEER'S NAME Last First Lic. No.
Engineers Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY 9'�
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Contractor's Address Contractor's E-mail Address
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City ra State Zip 2 % Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. - 1� • 211
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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