HomeMy WebLinkAboutXC2023-0186 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �Po" m
r Comm'I r Residential City of Newport Beach - Building Division oa+'g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ?�-D
F_Building r Grading
rDrainage i Elec r Mech r Plum CuYdCut F CuYdFill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
Uses Const Type F
P
(or Y t
# Stories # Units (if Res)s
p
s
Valuation
New/Add SFF--
Remodel SF F_ Gara e/New/Add �
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2) Q
Material/Laa bor 6
OWNER'S NAME
Last p /I v .1 First
Owner's Address
Owner's E-mail Address
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City IV C`��� /I -f'
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�2�L`�} State C1i� zip Telephone�.�..���
v2c 3 Telephone -
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APPLICANT'S NAME
Last fill , UAy Cv7V_ First
Applicant's Address
Applicant's E-mail Address
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w ud # l 0 1 Ck t tC vws g I I (,
City 1 „ J �'
State �_ Zip f Telephone C6 1 �� 21 G7_ 3 ) ) y
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ARCHITECT/DESIGNER'S NAME Last First --D
� Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip [ TelephoneF
ENGINEER'S NAME
Last �— First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City I
State F_ Zip (-_— Telephone[ —
CONTRACTORS NAME/COMPANY i M�6 C e S `M ' � / N C Lic No. F5Lf4s4S) � Class�S
` I CContractor's
Contractor's Address
E-mail Address
8-�a a (L d. i A �0 @ imaj-c s S t r. c o ,, .
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City 1 A
State Zip 1 Telephone 32.j 3 (- / 6 3-0
SETBACKS REAR
SETBACKS FRONT PERMIT NO.�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO I ` PLAN CHECK FEES $