HomeMy WebLinkAboutXR2023-1010 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application QA
F- Comm] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r- Flood r Fire r Liq j-- Landslide F N/A Floor Suite No
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Description of Work
Use F_ ConstType FV
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# Stories # Units (if Res)F
Valuation S
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Material/Labor �C ac—;6
OWNER'S NAME Last Cc -v2,
First i�•2.�iyy �,-„x.�
Owddn)�er's
Owner's E-mail Address
`Address
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APPLICANT'S NAME Last '' er v-,, &L L<
First ",i (
Applicant's Address
Applicant's E-mail Address
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City LC, +! State Fe,A
ZIP i-i(-:,o — Telephone i_(v el_-)k-,A,, I[,
ARCHITECT/DESIGNER'S NAME Last },�y�j First w�rLr Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Add
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Zip G111:�tJ r+ Telephone
ENGINEER'S NAME Last T'� f l {•
First 4,.L Ce A Lic NoFi,;Y cc 2
Engineer's Address
Engineer's E-mail Address
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Zip (�jj�.`;%�? Telephone t{-��— t`.�j — l."i(.=•
CONTRACTOR'S NAME/COMPANY(ti-� Yy/y /�� ,�._.. +�,y,� j� t�-".A.ic No (' �:Z'j�:y Class-
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Contractor's Address
Contractor's E-mail Address
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Zip f/;l.te'-� Tale phone "Ttz:��t 7 (e-11
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 'Vq"
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. > C '01V�0
USE ZONE
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DEVELOPMENT NO
PLAN CHECK FEES $