HomeMy WebLinkAboutXR2023-0681 - Permit ApplicationPrint Form g
,mil Worksheet for Combo Building &Solar Permit Application
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r Comm'I [X1Residential City of Newport Beach - BuildingDivision
`t NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding j- Grading [-Drainage (-Elec r Mech j-' Plum l�
Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) F Flood r Fire f . Liq f Landslide f_N/A Floor Suite No
O]ZEO E F F
Description of Work
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2-6V\ W � (� Cl�l Q # Stories # Units (if Res)[—
New/Add SFs-- Remodel SF F — Garage/New/Add F -- Valuation $ /
Material/Labor
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
city ICE (U tL � /nnC l 1 ` ,-L{- State �
Zip I / C - - Telephone---
APPLICANT'S NAME Last gc�lQS
First
Applicant's Address
Applicant's E-mail Address
City \ hGl cues CV K� a
�C�VW U� �� State �/ Zip CM Telephone /
ARCHITECT/DESIGNER'S NAME
ARCHITECT D , `
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Last First F
Lic. No. �--
ArchitectlDesigner's Address -
Architect/Designer's E-mail Address
City F State r__
I ZiP F� TelephoneF�
ENGINEER'S NAME Last
First �— Lic. No.�—
Engineer's Address
Engineer's E-mail Address
City State F- Zip - ZAP F--- Telephoned —_—
CONTRACTOR'S NAME/COMPANY
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Contractor's Address 1
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St(1_e� Contractor's E-mail Address �l)
City r Zt--
M—C C J � State I C P 5s lT%v/ Telephone
SETBACKS=REARSETBACKS FRONT
PERMIT NO.SETBACKSBACKS RIGHT_PLAN CHECK NO.USE ZONEELOPMENT NO
PLAN CHECK FEES $