HomeMy WebLinkAboutXR2023-0781 - Permit ApplicationL.
F rint Form__ Worksheet for Combo Building & Solar Permit Application
F Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f-Building F_ Grading FDrainage V_ Elec r Mech Plum r—
CuYdCutl Ci i V,t Giu I
Project Address (Not mailingaddress F_ Flood Suite No
) [Fire (- Liq r Landslide rN/A Floor
of Work Aol n t
New/AddSFI_ Remodel SFl—
OWNER'S NAME Last
Owner's Address
FTZR-_I.0_—Ai—el Ne-il2ar+ B -
Garage/New/Add F
Use F ConstType F_
# StoriesF_# Units (if Res)
Valuation $ �J
Material/Labor
First c
Owner's E-mail Address
city jJ eg o c� P ear IA State _ _ _ _
_ . - Zip
APPLICANT'S NAME Last
-!- � Cs1JC-Ro(a First
-
Applicant's Address Applicant's E-mail Address
_Gft�zpt
city -- -- -----—`-'�"I
� K �! (5 6 State � _ Zlp 61'18 o S Telephone /
_ - 7Y-3`17-Y?S�3
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
--
City State �-
First I Lic. No. �—
ArchitecUDesigner's E-mail Address
-- -
Zip Telephone —
ENGINEER'S NAME Last ' 1 p
T}r0 Sd(� First Lic. No.
Engineer's Address Engineer's E-mail Address
city AniF� �
jfc/NI Stateq- Zip Telephone7/j-.(030.-6��v
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City F_
SETBACKS REAR
SETBACKS LEFT
: l_71 00v ,s Lic. No. Wj7386 0ass�—
Contractor's E-mail Address
State �— Zip F—Telephone
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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