HomeMy WebLinkAboutXR2023-0385 - Permit ApplicationPrintForm - Worksheet for Combo Building & Solar Permit Application
EommI jiResidential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF Rt iRMITTAI c
FE,tiilding F_GradingF-Drainage F_Elec F_ Vlach Plum Cu Yd Cut F_Cu Yd Fill F_
Project Address (Not mailing address) f Flood F_ Fire F- Liq r Landslide i-N/A Floor Suite No
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Description of Work d V
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Use U I' /Const Type
#Stories #Units (if Res)
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Valuation �p 7� of
Material/Labor
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New/Add SF�— ReaaorJ€I SF Za �r Garage/New/Add
OWNER'S NAME Last 7�41 (7�j First
Owner's Address Owner's E-mail Address f
City _ - e Zip F—TelephoneF —
APPLICANT'S NAME Last 7/Z 6,,A k First I _�A ss)/
Applicant's Address Applicant's E-mail Address
_ �>✓iyti',g %tl/� U'�L� ( �i ���/`��/� Olds/
City _ �iii' OA S � •' State - p I1�,/o Z Telephone
ARCHITECT/DESIGNER'S NAME Last /� d//�7�/ First F/2/9 'U /)� Lic. No. C - 2 22ij
Architect/Designer's Address Architect/Designer's E-mail Address
City State —__?ip-F�— Telephone
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
City �- State F_ Zip �— Telephone
CONTRACTOR'S NAME/COMPANY �(ll'cn✓i' Yi v.� Lic No. �SG 7i Class !�
Contractor's Address Contractor's E-mail Address
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City I hlc4iic -2 State Zip 6?2e Telephone ,S/ -d 7S' I7/v
SETBACKS REAR SETBACKS FRONT PERMIT NOZ - Cis 4 S
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. OZ,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $