HomeMy WebLinkAboutXR2023-1119 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
r Comin'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .,,oa.•
Building rGrading rDrainage I-Elec rMech
rPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use Ffz— ConstType F
# Stories # Units (if Res)17
Valuation $
Material/Labor 2)ULiJ•
New/AddSFF— Remodel SF k272j Garage/New/AddF_
OWNER'S NAME Last
d. 61-) it
First
Owner's Address
Owner's E-mail Address
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City `/,
State �—
Zip F— Telephoned
APPLICANT'S NAME Last
C7h 55 C /1
First C
Applicant's Address
Applicants Address
rE-mail
CLvv-1
City ��.Z.U)V-4Y l')1(,rC�•.
State F.
Zip ,62_ Telephone CA_q. I�I'Z2Je.5
ARCHITECT/DESIGNER'S NAME
Last Cam$ j cvt
c Ft�� 't ��
First ,tj Lic. No. 2-I.3 IT
Architect/Designer's Address
Architect/Designer's E-mail Address
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(i A) cry Lb w-1
City Y1 M
State F___
Zip 71 jz 62 Telephone C1q l_�LZ`j�,SS
ENGINEER'S NAME Last
First 7— Lic. NoF_
Engineer's Address
Engineer's E-mail Address
City F_
State F_
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY
j
j 75Z Class 77
i / / _ y/ L'c No. Fit'
I
1
Contractor's Address
Contractor's E-mail Address
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City C•C,�.� }\ t $cam
State L�
Zip `rZC. �� Telephone ":[IY' �,9 (7( 7
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. `k "� 3 —'�k
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. �Q(iZlJL3 ` CiR�
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $