HomeMy WebLinkAboutXR2023-0871 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application s
F- Comm'I r Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j-Building F-Grading F-Drainage rElec [-Mech FPlum C�Yd cuts Cu Yd Fill
Project Address (Not mailing address) C Flood F— Fire (- Liq j— Landslide -N/A Floor Suite No
Description of Work Use Const Type t
77
TR�ts+9- I✓NC��ue� C�1}+✓�K -
# Stories # Units (if Res)s
—--------------- --
Valuation $
New/Add SF�— Remodel SF- �— Garage/New/Add �— Material/Labor p,
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OWNER'SNAME Last First
Owner's Address Owner's E-mail Address
City State Zip F— Telephones�
APPLICANT'S NAME Last N�5 First
Applicant's Address Applicant's E-mail Address
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City �.-0{pt\C�, State C� Zip aj2�g2 Telephone q$l 7I2 8627
ARCHITECT/DESIGNER'S NAME Last
First Lic, No. F—
Architect/Designees Address Architect/Designees E-mail Address
City State �— Zip I Telephones
--
ENGINEER'S NAME Last First T�
L Lic. No.—
Engineer's Address Engineer's E-mail Address
City State F77 ZiP Telephone
CONTRACTOR'S NAME/COMPANY -^� Lic. No. 300 ass
WELD IE% - __ - Hoc
Contractor's Address Contractor's E-mail Address 7 iqq 659
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City FIDPTJ�-QIA, State CIS Zip 9233(, Telephone 9(}j 35(o-If mg
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $