HomeMy WebLinkAboutXR2023-0831 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application W�R>
Comm'I F Residential City of Newport Beach - Building Division oa
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood r Fire Liq r Landslide F-N/A Floor
F Suite
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Description of Work
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Const Type s
# Storiess # Units (if Res)s
New/Add SFs— Remodel SF�--- Garage/New/Add F— Material/Labor
Valuation
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NER'S NAME Last Al
v' First A yl n
ner's Address - - - -- -
`/iG �VY�n Owner'sE-mail Address
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Zip Telephone
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ANT'S NAME Last FV
First
__ P_ii_n 61
nt's Address _ -- --
Applicant's E-mail Address
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- ^• ' Zip _� 1 d fn Telephone Fu _ 7, (0 )' UQJ 25
ARCHITECT/DESIGNER'S NAME
Last First
_ Lic. No. �---
Architect Designer's Address Architect/Designer's E-mail Address
- -
CityState Zip
�— Telephone
ENGINEER'S NAME Last
- First F� Lic. Nos--
Engineer's Address Engineer's E-mail Address
- -
- - -
City State ZAP Telephoner
CONTRACTOR'S NAME/COMPANY t b 53 elSClass � ,—
I I 1 1 N Lic. No. Ip
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT A���/ 1383�
PERMIT N0. A
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (i
USE ZONE
— DEVELOPMENT NO PLAN CHECK FEES $ bO2jG