HomeMy WebLinkAboutXR2023-0265 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application SEW°�Rr
','Residential
City of Newport Beach - Building Division 7y) �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4 atja 3 u :�
I"uilding i Grading f—Drainage rElec F_ Mach F-Plum CuYdCut l CuYdFill [_
Project Address (Not mailing address) C Flood r Fire F_ Liq r Landslide f_N/A Floor Suite No
Description of Work Z
Use Const Type
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# Stories # Units (if Res)
New/Add SFF__ Remodel SF Z/ 2� C t Gara e/New/Add �—
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Valuation a e1
Material/Labor 7 C
OWNER'S NAME Last ` �cL(r' � First
Owner's Address
Owner's E-mail Address
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j� �j IBC t�;k't ter-�
City K- (C B 1F— C cv 1 State — 1
__ ir f\ ZIP Telephone[2,�2,
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APPLICANT'S NAME Last V C'( L
/ � First
Applicant's Address Applicant's E-mail Address
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CIO i_A
city t
State
to p Zip Cj vjy Telephone 2-�
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ARCHITECT/DESIGNER'S NAME Last First r Lic. F�
No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip �— TelephoneF—
ENGINEER'S NAME Last First
- Lic. No.F—
Engineer's Address Engineer's E-mail Address
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City State r—� Zip I Telephoner--
CONTRACTOR'S NAME/COMPANY Lic. No. r-- Classr—
Contractor's Address Contractor's E-mail Address
City State r--- Zip r— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. , D `
USE ZONE ncvr-i —