HomeMy WebLinkAboutXR2023-2676 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ozWRe
F— Comm'I F_ Residential City of Newport Beach - Building Division o a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading rDrainage F_ Elec r Mech Plum Cu Yd Cut Cu Yd Fill l
Project Address (Not mailing address) f— Flood r Fire r Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F—ConstType F
to ZA
# Stories #Units (if Res)
Z 15 D 3A +
Valuation $ i too 0
Material/Labor
New/AddSFF Remodel SF� Garage/New/Add—
OWNER'S NAME Last �- _ ^ /uj> L[_G First
Owner's Address Owner's E-mail Address
City '/�, ,/ State Zip T/Rt�,Z Telephone
APPLICANT'S NAME Last " �� First
Applicant's Address Applicant's E-mail Address
City / �' _ State 7� Zip �(,/ Telephone r,z:,%
ARCHITECT/DESIGNER'S NAME Last G� First � Lic. No.���
Architect/Designer's Address Architect/Designer's E-rT l Address
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City -��<: State %7 Zip f l3l1 J Telephone
ENGINEER'S NAME Last First F_ Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F_ Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY `. Lic No. F�iGi� Class �j
X/ //
Contractor's Address Contractor's E-mail Address
City IC State ' Zip �� Telephone
,t/ (L
SETBACKS REAR SETBACKS FRONT ZWW MIT NO.
SETBACKS LEFT SETBACKS RIGHT We LAN CHECK ?41013 S
USE ZONE DEVELOPMENT N0PLAN CHECK FEES $