HomeMy WebLinkAboutXR2023-0885 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application
r— Comm'] iuResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF nF RI IRnniTToi o1
Building rGrading rDrainage r—Elec rMech j Plum cu vd cutF cu vd Fill
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Project Address (Not mailing address) F_Flood F Fire Liq F_ Landslide rN/A Floor Suite No
Description of Work
Use Const Type F
# Stories # Units (if Res)
New/Add SF� Remodel SF777
Valuation $ I(�
Garage/New/Add—; Material/Labor)
OWNER'S NAME Last...�.'�N ._...
_.....--. FirstNy
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Owner's Address
Owner's E-mail Address
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hce07157G
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City I "Fa-,,q '—�1 �i� State
Zi P c_, Telephone / I ' M7
APPLICANT'S NAME Last (,
First
Applicants/Address
Applicant's E-mail Address
City �L%TIVn1C�oN� State rC��
ZipTelephoneG7
ARCHITECT/DESIGNER'S NAME Last
�� �
Firstl�`"'1 \'�� Lic.No.I�1'�
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
I1 dL i'l�dtV sT_
City 1 � �TZ7r� State �C%�
Zip 'j Telephone
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F—
Zip �� Telephoned —
CONTRACTOR'S NAME/COMPANY
<M=r-L--`�, Lic No. F — Class
Contractors Address
Contractors E-mail Address
City _ -.-..., --._ State F_
Zip �— TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. k kU'Z 7 - OSB'S
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. t2Sr u-�v21
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $