HomeMy WebLinkAboutXC2023-0075 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
f Comm] F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building r Grading (—Drainage r Elec
r Mech r Plum cu vd cut— Cu Yd Fill F
ect Address
i
n
New/Add
r Flood r" Fire r Liq r Landslide
of Work
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OWNER'S NAME
I —N/A Floor
Suite No
F--
o- F/
Use ConstTypeF
# Stories[— # Units (if Res)[_
Remodel SF lM —� Garage/New/Add — (Valuation $ _/ Material/LaborFbto
Last
First
Owner's Address �. CUB ' Owner's E-mail Address
City State F— Zip [� Telephone[�
APPLICANT'S NAME Last %�R1A O?
Applicant's Address
First
73.)T v Applicant's E-mail Address
J V r�- c� /-Ive "
City /C!12/P (" State Z. /126 Lrn .v�jllx
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ARCHITECT/DESIGNER'S NAME
�P /L)L%Jy Telephone 3`� z2SU `
Last f0X First b
Lic No
Architect/Designer's Address
City I ( c)'�- Aai1e%f
State I r/-*--
Architect/Designees E-mail Address
oj eryj� � 1'c tclxl twZa
v��i'4cfr.��r
Zip C��� Telephone 73
ENGINEER'S NAME Last �/l� p �f�`� �;pf
/ First 5'Ci%%d %TCOtyr Lic. No. ��'�
Engineer's Address J
Engineer's E-mail Address
city c% I
f � �,�. , State C Zip Telephone
CONTRACTOR'S NAME/COMPANY �nt
5%ATE �ir�N, C�/UU��/y /%� �Cht)J'--/ufcZ.; 1dtJC. Lic.No.�— Class
Contractor's Address
Contractor's E-mail Address
36 i �, EGA/1l� s 7-W City i57/45�1i;w State I ZAP / ��JTelephone !J�
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
2
PERMIT NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $