HomeMy WebLinkAboutXR2023-1040 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application OTE
r Comm] r' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage r Elec r Mech r Plum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) r Flood r Fire j— Liq r Landslide I —N/A Floor Suite No
Description of Work
Use I— ConstType
I
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#Stories #Units (if Res)
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Valuation $lG
Material/Labor
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last
4 First �E�
Owner's Address
Owner's E-mail Address
17 :�J_f 25 ✓j #
City U 5 l `/A_1
State �� Zip Telephone 7Ll 5-5 Z 10y
APPLICANT'S NAME Last
G�� �First J 7
Applicant's Address
Applicant's E-mail Address
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City
State Zi 12_ 701�, Tele hone 7/Lf �U7.� 72f "7
p CG�First
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ARCHITECT/DESIGNER'S NAME
Last Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F___ Zip F_ Telephoned
ENGINEER'S NAME Last First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic No. lUEG SU%£lass�
I `°vC� t✓
Contractor's Address
Contractor's E-mail Address
ZZ 3 I77Ffro
�v /' wG OC CC�Jo -
City-Gc_Gi� �,.(�j
State � Gam- Zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. xt
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. /G2-0"'h
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $