HomeMy WebLinkAboutXR2023-2567 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F Comm] )Residential City of Newport Beach - Building Division
NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading rDrainage r Elec [_ Mech
r Plum CLYdCut [_ CuYdFill F_
Project Address (Not mailing address) F_ Flood
j- Fire r Liq r Landslide f N/A Floor Suite No
Description of Work
Use F Const Type
DNF-wL� ,a Sl y
Qa RA
# Stories[ # Units (if Res)F
'l
Valuation $
Material/Labor
New/Add SFF Remodel SFF Garage/New/Add F—
OWNER'S NAME Last F LO<,�tyL_
First I H1CV) 0L-"L,
Owners Address
Owner's E-mail Address
2`t o VW ov V-' v tt) 9 p-
MA ARdAoI A(,-VQA Nth
City J� / US State C A
Zip �'� 3D. Telephone Wa_� — c( �' $l ls'
APPLICANT'S NAME Last-��t✓ j�
First
Applicant's Address
Applicant's E-mail Address
City NL''�'��� iState I E; —
Zip I ( e(b Telephone
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
IS'ti �M\Js 1p� S-Tit Gr-1
City State I �W
n —t
Zip F'�, Telephone 3 1 4 -- Tr%�-- 4,il-o
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F—
Zip F— TelephoneF—
CONTRACTOR'S NAME/COMPANY r3
" _J
Lic No. ffb L Class
Contractor's Address
Contractor's E-mail Address
City %3:oAc ea State I (' —
Zip �'}�(p 6 Telephone Clil — 2 ~4
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S