HomeMy WebLinkAboutXR2023-0405 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
TCityof Newport Beach - Building Division mm'I esidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V !
P uilding F Grading f-Drainage j-Elec FMech F" Plum Cu Yd Cut Cu Yd Fill
Project (Not mailing address) [ Flood [_ Fire [- Liq F- Landslide f N/A Floor Suite No
7;ress
tn2p�
Description of Work. /G
Use �- Const Type -A
#Stories # Units (if Res)F
Gudv /a�,� `�L/�G S� �`� ,
�%'� y�
�--� %Jit-/� fAi
New/Add SF JZ F yTd
�— del SF ZGC2 4 Garage/New/Add �—
Valuation $ cC
Material/Labor
/i
OWNER'S NAME Last First
- �`-
- -
Owner's Address
Owner's E-mail Address
Ci State -
- - Zip �— Telephone--
--
APPLICANT'S NAME Last //Z�j!'x First
Applicant's Address Applicant's E-mail Address
C c rt-;
CityR) /"_A SLR! Z5 State T ZiP 7 z_& /�- Z Telephone � 77
ARCHITECT/DESIGNER'S NAME , p
Last .. �/¢ /L! ��� First l"�a�ll,� i� ✓ Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
—
City State__,— ip _-Telephone
ENGINEER'S NAME Last First Lic. No,
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. F7554 Class R3
Contractor's Address Contractor's E-mail Address
i -
City State F Zip--- Telephone
SETBACKS REAR SETBACKS FRONT PERMIT N0. /\ (( (_(rL j - O(40 t'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $