HomeMy WebLinkAboutXR2023-0367 - Permit Application1 _ Print Form Worksheet for Combo Building & Solar Permit Application F'M'No,
City of Newport Beach - Building Division
comm"eft sidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u „..
F-wilding r Grading F-Drainage F_Elec F-Mech F- Plum C.YdCutl G CuYdFill `�
Project Address (Not mailing address) [ Flood F_ Fire f— Liq r Landslide CN/A Floor Suite No
Description of Work
Use ConstType I/
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# Stories # Units (if Res)F
New/Add SF Remodel SFGarage/New/Add F
Valuation $
Material/Labor ley 600
OWNER'S NAME Last �. pjl�f/� First /YI
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Owner's Address Owner's E-mail Address
cityState Zip G Telephone _ c _
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City State Zip Telephone G/
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ARCHITECT/DESIGNER'S NAME Last First � r✓e$ Lic. No. -lf ?
Architect/Designer's Address Architect/Designer's E-mail Address
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City 1 State �— Zip G
l mac« ` Telephone jG� 6�,F
ENGINEER'S NAME Last �� First F Lic. No f
Engineer's Address Engineer's E-mail Address
City State F_— Zip I TelephoneF_
CONTRACTOR'S NAME/COMPANY / � v�f Lic No. — 2-103 lass 3
(� � ✓10� Contractor's Address Contractors E-mail Address
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City 7�7State �- Zip 1ij27e,i/ Telephone �7f,�?_3y20A?�,
SETBACKS REAR SETBACKS FRONT PERMIT NO. xe-ZOZ-;
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $