HomeMy WebLinkAboutXR2023-2339 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o4�Ew°°RB
Residential r Comm] Residential of Newport Beach - Building Division jc _
// NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage rElec rMech
r Plum CuYdCut CuYdFill
Project Address (N(A/ot mailing address) f Flood r Fire r Liq r Landslide I —N/A Floor Suite No
Description of Work
Use F—Const Type
t Jl ' V+-L7`'3L ♦.np.ry W l
#Stories #Units (if Res)
i7
New/AddSFF— Remodel SFF— Garage/New/AddF —
Valuation $
Material/Labor 000
OWNER'S NAME Last First
Owner's Address
Owners Address
�E-mail
/ "
City t in} fF V Ci \ State F �
Zip �— Telephone `7�
APPLICANT'S NAME LastF_U Cu
First q ",
WVtIt,e
Applicant's Address
Applicant's E-mail Address
/
City � State F—
Zip Fi TelephoneF_—
ARCH ITECT/DESIGNER'S NAME Last
First— �—
Lic No.
Archract/Designer's Address
Architect/Designer's E-mail Address
City I State F—
Zip F— Telephoned
ENGINEER'S NAME Last
First F Lic. No. F—
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY \ c+t� i %(— Li No. jQL^q '11 Class
Contract(o�r's Address
Contractor's E-mail Address
ln' �
City �, \„ L��� State FN_ZjP
Y'W
r � Telephone[ —At � 7
SETBACKS REAR SETBACKS FRONT
PERMIT NO. _Z33 t
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $