HomeMy WebLinkAboutXR2023-2562 - Permit Application°
Print Form Worksheet for Combo Building & Solar Permit Application @Jl(w
City of Newport Beach - Building Division
r Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j-Building r Grading rDrainage r Elec (- Mech
(- Plum CLi Yd Cuts Cu Yd Fill
Project Address (Notmailingaddress) I- Flood
r Fire r Liq (- Landslide rN/A Floor Suite No
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Description of Work
Use s ConstType s
it Stories k Units (if Res)s
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Valuation $ C
Material/Labor 2 J 1 wo
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New/Add SFs� Remodel SFr Garage/New/Add I
OWNER'S NAME Last ,11 w _ \'
First � 0-0 t r!
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
First VAt��
Applicant's Address
Applicant's E-mail Address
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Zip q�L �S Telephone
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. r—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip F Telephoned
ENGINEER'S NAME Last �—
First r Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City Stale F_—
Zip F— Telephoned
CONTRACTOR'S NAMEICOMPANY P tV l
Lic. No. � (� j 2-1-S Class (✓ Z5
Contractor's Address
Contractor's E-mail Address
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City tJSVp,� CAP, 10y r Slate 1 �1 —
Zip Telephone c;)E JJW--a -72-,
SETBACKS REAR SETBACKS FRONT
PERMIT NO. )(82023- 2562
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 2QZdq22233
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USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $