HomeMy WebLinkAboutXR2023-1102 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j Comm'I j�Residential City of Newport Beach - Building Division ; g
J \ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G...o„••'
wilding r Grading rDrainage i- Elec r Mech r Plum CuYdCut F CuYdFilt
Project Address (!!!et mailing address) r Flood j— Fire j-- Liq r Landslide I —N/A Floor Suite No
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Descaptlati of Work
Use P Const Type
# Stories # Units (if Res)
New/Add SF Remodel SF �— Garage/New/Add �—
Valuation $
Material/Labor . tL
-MMM NAME %TZ�/� Last ��
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Owner's Address � e ZZ) Owner's E-mail Address
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City �U)�� State Zip/Z�j/ Telephone
APPLICANT'S NAME Last ` .C7 First
Applicant's Address Applicant's E-mail Address
City State Zip ` Telephone C /' 27 -�, �✓
ARCHITECT/DESIGNER'S NAME Last First 7— Z 5� 7
Lic. No.
Architect/Designees Address is E-mail Address
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City State Zip I TelephoneF
ENGINEER'S NAME Last �l/I if;�� ]/ First' fy' `� Lic.No. ���i��
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Engineer's Address Engineer's E-mail Address
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City 71 f, Lovlt. -Zr%Jf State Zip %/ y Telephone-7/�tJj /
CONTRACTOR'SNAME/COMPANY. r �C� s�� � � Lic.NoT Class
Contractor's Address Contractor's E-mail Address
City State Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. XK i,'{,�';? --- �•�'_�; �,,:
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. N� ��� „Y'LJ ` U Cf ,. (y
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $