HomeMy WebLinkAboutXR2023-3184 - Permit ApplicationPrint Form
r Comm'I
Workshee* ",)r Combo Building & Solar P—mit Application
Residential City of Newport Beach - Building Divis.
NOTE: PLAN CHECK FEES pUE AT TIME OF SUBMITTAL
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Grading rDrainage �'Elec Mech
Um Cu yd cut Cu Yd Fill
/Building
Project Address (Not mailing address) F_ Flood
r Fire r Liq r Landslide F_N/A Floor Suite No
Description f Work
Use r//_,y Const Type
G
# Stories #Units (if Res) _17-
"
Valuation
Material/Labor
New/Add SF F Remodel SF �3% �� Garage/New/Add
OWNER'S NAME Last
First /
Owner's Address
Owner's E-mail Addres "
City State G' ;
Zip z Z Telephone-
i
APPLICANT'S NAME Last
First
Applicant's Address!/ //�j��j��j j
cant's E-mail Address
City State
Zip F Telephoner
ARCHITECT/DESIGNER'S NAME Last /
//f
First %� Lic. No.
Architect/Designer's dress
Architect/Designer's E-mail A dress
y erns
`e; .� s D i � r
City 0&11fP ' State G/�
Zip Q� T phone /
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/
ENGINEER'S NAME Last / / %`l CO�
C/V J
First Lic. No.7j 3
Engineers Address
Engineer's E-mail Address
City 14z�zwv/, / G State / /'
C''
6 / Zip 07 Telephone �%/ ��,� j��
CONTRACTOR'SNAME/COMPANY X
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
city I State
-
Zip F Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ?'" ?�l CD--
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. e ?�OZ?7, 2, Z
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $