HomeMy WebLinkAboutXR2023-1307 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I y Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r uilding F_ Grading F—Drainage rElec (--Mech F-Plum Cu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) F Flood F- Fire j-' Liq r Landslide FN/A Floor Suite No
Description of Work
Use r- ConstType F
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#Stories #Units (if Res)
New/Add SF � Remodel SFF— Gara e/New/Add
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Valuation $�j
Valuation $ or 1t
OWNER'S NAME Last n (t
-e-_/J }'\2 l First
Owners Address Owner's E-mail Address
City (l �, a to �� Zip �—� V . ✓l� Welephone
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APPLICANT'S NAME Last` First (,C
Applicant's Address Applicant's E-mail Address
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City -V,4 C-_ . D State Zip r. �Cb Telephone 5{[ C) Zl,l �f , �l[ 1/
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City I State F Zip [— Telephoner
ENGINEER'S NAME Last �— Firstr Lic. No.F_
Engineer's Address Engineer's E-mail Address
City--- State F— Zip r-�--, Telephone[
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CONTRACTOR'S NAME/COMPANY U � ! O Cal ((-I . No. r rq �JClassr
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`Address
Contractor's Address Contractor's E-mail
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City �fl fState Fo— — Zip Telephone vrSC, ,3)
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X ti-to7 J _ ,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (PCZ67,;
USE ZONE DEVELOPMENT NO FZWLZ _a�ZPLAN CHECK FEES $