HomeMy WebLinkAboutXR2023-2487 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm1 j- Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood F_ Fire r Liq j— Landslide FN/A Floor Suite No
Description of Work
Use ConstType
# StodesF # Units (if Res)F
Valuation $
Material/Labor
New/Add SF�- Remodel SF �- Garage/New/Add �—
OWNER'S NAME Last
1 J) Q First
Owner's Address Owner's E-mail Address
city a State Pk Zip Telephonei9
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APPLICANT'S NAME LastFs-t t'+ First Nj6 US
Applicants Address Applicant's E-mail Address
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City C' (> pt� Qs,_ State I 01 n Zip 9a'7Dg- Telephone'] fy �3�
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ARCHITECT/DESIGNER'S NAME Last First F_Lic. No.
Architect/Designefs Address Architect/Designer's E-mail Address
City _ _ State �— Zip F_-- Telephone,—
ENGINEER'S NAME Last X f 1 tit' First 119 ( Lic. No. `j g
Engineer's Address Engineer's E-mail Address
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City S (1 ,� State Zip I� a� Telephone '7 ) �O h U I D
'M�PANY
R'S NAMEIC�`Of
CONTRACTO /' � t Lic. No. -7 44� Class 11
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Contractor's Address Contractor's E-mail Address
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City rState Zip '% Telephone 1 4
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SETBACKS REAR SETBACKS FRONT PERMIT NO. �RW .5- 2 1O-7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $