HomeMy WebLinkAboutXC2023-0145 - Permit ApplicationPrint Forrn Woi ksheet for Combo Building & Solar Permit Application
Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑ Grading ❑Drainage $ Elec Mach Plum I�
Cu Yd Cut i Cu Yd Fill I
Address (Not mailing address ❑ Flood Fire I—
❑ ❑ Liq ❑Landslide gill Flloorr Suite No
in of Work
Use onst Type
# Stodes� # Unfts (if Res
New/Add SFE I Remodel SF Valuation $ 76v]Garage/New/Add Matedal/Labor
OWNER'S NAME Last ZKI/INk�
First
Owners Address 1
Owner's E-mail Address
city Z�/jA(� state (�7 G ZIP Telephone q�% -71-1,m
APPLICANT'SNAME LastM
First
Applicant's Address
f Applicant's E-mail Address
City L(�- State ZP Z f7 Telephone Z - "1.� ]ij �O
ARCHITECT/DESIGNER'S NAME Last
�)\ ;�i7 First Pz4L + Lic No.
A chitecUDesigner sAddress Architect/Designers E-mail Address F
City State {� —
zip Telephone
ENGINEER'S NAME Est — — —� First
t
L � Lic No.� �
Engineer's Address Engineer's E-mail Address _
I
City ----r�--� (---- ---- _�
State Zip I .! Telephoned
CONTRACTOR'S NAME/COMPANY P. L— Lic. No,
1�I
Contractor's Address 1� IClass(
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In o CCContractoEmall A ress�
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City \� j (� State �ll zip
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
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a5o 134g
USE ZONE DEVELOPMENT Nn
PERMIT NO. _ —
PLAN CHECK NO.