HomeMy WebLinkAboutXC2023-0087 - Permit Application__Print Form
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Worksheat for Combo Building & Solar Permit Application
1 City of Newport Beach - Buildino Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building f- Grading F-Drainage N7Elec �Mech lum CuvdCut F CuvdFill op
Project Address (Not mailing address) [ Flood F_ Fire r Liq r Landslide f N/A Floor Suite No
Description ofWorh N i/1 Use I— Const Type
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# Stories #Units (if Res)
Q1ii/J DLO T� cc) �JOGG f1��TE/Z1 /� 7ti4$ .
Valuation $ _
New/Add SFF— Remodel SF�_— Garage/New/Add �— Material/LaborF�Q,000
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City-- State-- Zip F_ Telephonef -
APPLICANT'S NAME Last
GHS/Z'cL�17��TS First
Applicant's Address Applicant's E-mail Address
City - State �— 9Z7_
ri4 Zip Telephone
ARCHITECT/DESIGNER'S NAME
Last </'/S �c��- First F_ Lic. No.�
Architect/Designer's Address Architect/Designer's E-mail Address
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City CG�T. f7�'S� State e� Zip PZZ7 Telephone--
ENGINEER'S NAME Last First Lic. No.7—
Engineer's Address Engineer's E-mail Address
City State �a Zip Telephone�—
CONTRACTOR'S NAME/COMPANY Lic No. F-- Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.210
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Gw OV r�
11CC 7111,