HomeMy WebLinkAboutXR2023-1424 - Permit ApplicationPrint Formes Worksheet for Combo Building & Solar Permit Application
j— Comm'I I ' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Wuilding r Grading F—Drainage F Elec r Mech
r Plum cuvdcut [_ cuYdFill F_
Project Address (Not mailing address) r Flood
F_ Fire F_ Liq r Landslide FN/A Floor Suite No
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CA ot26 (.1 F F
Description of Work
Use F_ ConstType
# Stories[— # Units (if Res)F_
_
Valuation j t
Material/Labor
New/Add SF F Remodel SF F Garage/New/Add F—
OWNER'S NAME Last S} .an
First \(a.wrSS q
Owner's Address
Owner's E-mail Address
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City i�c ��a�� State F CA
zip qLC(.} TelephoneF
APPLICANT'S NAME Last f..,:bys 1 rcY„
First
Applicant's Address
Applicant's E-mail Address
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City I lwc-�.'pe� State CA
Zip GS Telephone 9q Sly 42gr.`
ARCHITECT/DESIGNER'S NAME Last
First F_
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip F__ Telephoned
ENGINEER'S NAME Last
First FQ1Q Lic. No. C
Engineer's Address
Engineer's E-mail Address
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City L� rl�,�,,,i,� State -c A
Zip-n Telephone Fit
CONTRACTOR'S NAME/COMPANY M�r_�1 Lic.No. I_��57° Class
Contractor's Address
Contrractor's E-mail Address
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City I k,(Cjr7, State LA-
Zip q'�,(� (, Telephone (eZ4 'tn b5s-v
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK No. '\7,('
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S