HomeMy WebLinkAboutXR2023-0748 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
[ Comm'I ❑Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE T TIME OF SUBMITTAL °•""
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Project Address (Not mailing address) ❑ Flood ❑ Fire [ Liq [ Landslide ❑N/A Floor Suite No
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of Work
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New/Add SF Remodel SF 165'(l Garage/New/Add
OWNER'S NAME Last
Owner's Address
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First
Owners E-mail Address
City rJGt.�NPEA0 T_ State I -' Zip
APPLICANT'S NAME Last
Applicant's Address
City ������ State
First
Use 301 Const Type
# Stories # Units (if Res) --1
/,474 S
Valuation
Material/Labor
Applicant's E-mail Address
Zip TelephoneI Z S(
ARCHITECT/DESIGNER'S NAME LastFirstLic. No.
Architect/Designees Address
City State L
Architect/Designer's E-mail Address
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Zip 7C/p3 J Telephone12s"�r "Z i4
ENGINEER'S NAME Last 'V.% B ri First Lic No. CS�O `jam
Engineers Address
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City I, State
Engineers E-mail Address
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Zip q2 Telephone[%1Lj _,Sg ,f
CONTRACTOR'S NAME/COMPANY 1�I'�gyr 4—,614p jn Lic No. IOc/ g S ' � Class
Contractors Address
State
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
Contractors E-mail Address
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Zip Telephone 3-j
PERMIT NO. /dye- '10 7,, '
PLAN CHECK NO. ' G IF(/Ti�j"
PLAN CHECK FEES $