HomeMy WebLinkAboutXR2023-3284 - Permit ApplicationPrint Form `dVorksheet for Combo Building & Solar Permit Application
F Ccmm'I (— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j- Grading (—Drainage F Elec F ech [-Plum Cu vd Cut F_
Cu vd rill F_
Project Address (Not mailinsa addressl f Flood F Fire f Lia r Landslide [_N/A FI
PA NGII} Aire
Description of Work
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New/Add SF 'f ( Remodel SF i f�— Garage/New/Add NN//h
OWNER'S NAME
Owner's Address
#i5 Lv 7or
City 6000,111
APPLICANT'S NAME
Applicant's Address
Last /K OA.
First I 7,g%O,
Owner's E-mail Address t/
State l� Zip J/
Last I ` C,, DA
City 1 r7LPWiN y?/ 1` State }
ARCHITECT/DESIGNER'S NAME Last r—
oor
Suite No
Use R ConstType v/5
# Stories # Units (if Resf j
Valuation $
Material/Labor /u .400
i
First) pl�l/•N
Applicant's E-mail Address
Zip ail �0 G Telephone 67Z�-
First
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip [ TelephoneF
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKSREAR
SETBACKSLEFT
USE ZONE
First
Engineer's E-mail Address
State F Zip F_ Telephone
Lic. No. F_
Lic.
Lic No. F— Class
Contractor's E-mail Address
State F Zip F_ Telephone[ —
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. O ► ft
PLAN CHECK NO. Z�
PLAN CHECK FEES 5