HomeMy WebLinkAboutXR2023-1127 - Permit Application__ Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F�idential City of Newport Beach - Building Division {= �
NOTE: PLAN CHECK FEES DUE AT TIME ()FRI IRMITTAI
r�ilding F_ Grading [`Drainage (-vEl-,ElF-vMech [-✓Plum CuYdCut F CuvdFill F
Project Address (Not mailing address) F Flood r Fire F_ Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use ConstType F_
IN � � OOtt.) 1?-€t't-JtCfwl>=N� ii /-(,mac . (o L prvl /i F-F ✓� C,
# Stories #Units (if Res)
Valuation $
Material/Labor Flua( 0
New/AddSFF— Remodel SFF -- Garage/New/Add —
OWNER'S NAME Last
Owners Address Owner's E-mail Address
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City N State C p
- - - Zip i2.64�P Telephone 5gc(_673-_(-767
APPLICANT'S NAME Last TA iV 2!J First
Applicant's Address Applicant's E-mail Address
9-6,1_Al--a L (LiJTA MAtrL-GD>L(
City State �- Zip c/�— Telephone °1tE�P_
ARCHITECT/DESIGNER'S NAME Last ulLls€ First—
_..__ Ptt1�tp Lic.No.r—
ArchitecUDesigner's Address Architect/Designer's E-mail Address
6131 �ev�CraPA Q2. HQ-, _ PNI'LN) s�ooQy, �t�o.-cam
City } hj - State C+°F Zip gZ647 Telephone 71 A}-
ENGINEER'S NAME Last First Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State �® Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. �— ClassF_
Contractor's Address Contractor's E-mail Address
City State F Zip F_ Telephoned®
SETBACKS REAR SETBACKS FRONT PERMIT NO.
12SETBACKS
LEFT SETBACKS RIGHT PLAN CHECMR-
USEZ3-'
ZONE DEVELOPMENT NO PLAN CHECK FEES $