HomeMy WebLinkAboutXR2023-2447 - Permit Applicationt Form _ Worksheet for Combo Building & Solar Permit Application NfWPo,
I Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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g r Grading (Drainage r Elec Mech
I`plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) f Flood F Fire F- Liq (- Landslide RN/A Floor
Suite No
AL��SAN�Ril� I 6 F
Description of Work
AbD IT' ot� OF Z4S 5P p Use ConstType �r8
E RLL� N To Fp
i - # Stories # Units (if Res)
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1 New Ad SF� Valuation $
`Z�t Remodel SF F— Garage/New/Add �— ,pp,
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Material/Cabo ®/ ®®�7
OWNER'SNAME Last ALAMEDL�1 �(E -
- First i 5 HA H
Owner's Address - -
Owner's E-mail Address
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City AC 41 State CA Zip
92�5] Telephone -1A 1 �-7
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APPLICANT'S NAME Last
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Applicant's Address
4 `® Applicant's E-mail Address
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��-N OAkS State Fe Zip ct\"3 Telephone
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ARCHITECT/DESIGNER'S NAME
Last �-P�"F/4'�� First 3�
Architect/Designer's Address Lic. No. C�8
Architect/Designers E-mail Address
City _ - -- - - -
State
Zi
�— Telephone
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ENGINEER'S NAME Last
First® Lic. No f�
Engineer's Address _
Engineers E-mail Address
City - - -
State �
Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY �fQ
�w• I'V�_ _. (�� Lic No. �— ClassF
Contractor's Address
Contractor's E-mail Address
City
State F Zip Telephoneh
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. 2023 • Z
PLAN CHECK NO. C_O --
PLAN CHECK FEES $