HomeMy WebLinkAboutXR2023-2135 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4�EW�"a
Fomm'I �sidential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�uilding [- Grading [—Drainage [- Elec [- Mech
[- Plum cuvdCut F cuvdHI F
Project Address (Not mailing address) r Flood
[- Fire [- Liq j— Landslide [-N/A Floor Suite No
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Description of Work z
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Use` = A . Const Type l
# Stories 77 #Units (if Res)
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AS / _AID ling F6izlj
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Valuation $ / C�
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New/Add SF� IlemedetSF F
2� Sl Garage/New/Add
Material/Labor /
OWNER'S NAME Last /fJ' �j��/�i
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p First
Owner's Address
Owner's E-mail Ad
City a e
Zip I TelephoneF—
APPLICANT'S NAME Last�
First A
Applicant's Address
Applicant's E-mail email Addr" ss
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City )'�W o,4 A £ 4NJ State �
Zip 7/�� Z Telephone 2� -- 6 —, 1/ t
ARCHITECT/DESIGNER'S NAME Last I /2 Ayu, golG _l First /2-A VZ) Lic. N _z Z (-
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Architect/Designer's Address
Architect/Designer's E-mail ddress
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City
Zip Telephone
ENGINEER'S NAME Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State
Zip F— Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- Class
Contractor's Address
Contractor's E-mail Address
City State
Zip F— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. -?L I��S
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $