HomeMy WebLinkAboutXR2023-2621 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application /a°_e NRm
j- Comm'I F_ Residential City of Newport Beach -Building Division i
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r uilding r Grading (—Drainage r Elec F_Mech r Plum Cu Yd Cutl Cu Yd Fill F_
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide f N/A Floor Suite No
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Description of Work
Use F—ConstType
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15
# Stories 1 0 # Units (if Res) 5u
Valuation
Material/Laa bor
New/Add SF�— Remodel SF Garage/New/Add F—
OWNER'S NAME Last b� � �` 1-(oj� - First
Owner's Address Owner's E-mail Address
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City W ,,,/ [L��1 State F Zip= Telephone 2I(� (LQL�
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APPLICANT'S NAME Last tr First / a itN
Applicant's Address Applicant's E-mail Address
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City c Ari �eL Y V Wp k State �— Zip G Telephone "), n 3 � 99 If
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ARCHITECT/DESIGNER'S NAME Last First Lic No. F_
ArchitecUDesigner's Address Architect/Designer's E-mail Address
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City State F— Zip I TelephoneF
ENGINEER'S NAME Last_ Firsts Lic.
Engineer's Address Engineer's E-mail Address
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City State F— ZipF� Telephone[
CONTRACTOR'S NAME/COMPANY Lic. No. Classr
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Contractors Address Contractor's E-mail Address 2 .
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City C 0,5ft, kC, State /,j— Zip) Telephone q LJ 1,� 3
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SETBACKSREAR SETBACKS F'R\ON-•Tl
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES