HomeMy WebLinkAboutXR2023-1709 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF�
r Comm'I (Residential City of Newport Beach - Building Division 5
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [_ Grading rDrainage r Elec r Mech
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Project Address (Not mailing address) F_ Flood
F_ Fire F_Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type
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# Stories If Units (if Res)[—
New/Add SF� Remodel SF F— Garage/New/Add F—
Valuati n $F&,U�C7
Materia or
OWNER'S NAME Last
Owners Address
Owner's E-mail Address
City 361=�C [-t State FZ7��
Zip i 2 CT? cD TelephoneF
APPLICANT'S NAME Last 40&- L--
First
Applicant's Address
Applicant's E-mail Address
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Zip t2(,ECG Telephone'7V� "f?z l66 q
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City I State F_
Zip F_ Telephoned
ENGINEER'S NAME Last
First— Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY �
L� ��SE < }Get Lic No. FZ97175 ClassF
Contractor's Address
Contractor's E-mail Address
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City PC, State F�—__
Zip C O Telephone elq 1 427 1 LC C7
SETBACKS REAR S BA KS F ONT
PERMITNO.SETBACKS
LEFT HT
BPLANCHECKNO.USE
ZONE ENT NO
tVLP
PLAN CHECK FEES $