HomeMy WebLinkAboutXR2023-1402 - Permit ApplicationPrint Form 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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uescription of Work
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r Flood r Fire r Liq r Landslide
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OWNER'S NAME Last r B `
First I D -:V,
f N/A Floor
Suite No
Use Const Type
# StohesF_ # Units (if Res)[—
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abor ts, OQU
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME
Last
Applicant's Address
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City I l V 2
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Applicant's E-mail Address
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Zip — Telephone `%Z)5. 53 7� • 6ti Jt�
ARCHITECT/DESIGNER'S NAME _
Last �cZ , � First FJVct U
Architect/Designer's Address
Z ArchitectlDesigner's E-mail Address
city
State �C-�.'+- Zip c!z('•,'� �j Telephone j c
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ENGINEER'S NAME Last Vv' �S C �3753
Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY /
LicNo.F_ ClassF-
Contractor's Address
Contractor's E-mail Address
State 5�6U
city I State F_
Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT ' 4�Z
PERMIT NO, t4
r.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PG ip2.3. O2oFJ
USE ZONE DEVELOPMENT NO --
PLAN CHECK FEES $