HomeMy WebLinkAboutXR2023-0774 - Permit Application1--Pri t Form Worksheet for Combo Building & Solar Permit Application (605"h5o
City of Newport Beach - Building Division
r Comm'I j Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
1KBuilding [Grading F—Drainage [Elec F_Mech F—Plum Cu Yd Cut1-7 Cu Yd Fill
Project Address/((Not mailing address) C Flood r Fire j— Liq r Landslide CN/A Floor Suite No
Description of Work
Use Const Type
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# Stories? # Units (if Res)F_
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Valuation $ S d Q
Material/Labor
New/Add S -- Remodel FGarage/New/Add
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OWNER'S NAME 1/ ' n
Last ._1����WI`_ _...__.- First—_.��_����Owner's
Address Owner's E-mail Address
City State F_N Zip O 2 TelephoneF_—
APPLICANT'SNAME Last I ��— First
Applicant's Address Applicant's E-mail Address
11 �n � 7
City --- �rAe State Zip p)// Telephone 7iy Zj7_ /73
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ARCHITECT/DESIGNER'S NAME Last First F Lic.
ArchitectlDesigner's Address
chitect/Designers E-mail Address
City State F Zip F Telephone
ENGINEER'S NAME Last First 777777 Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State �� Zip F_�Telephone�—
CONTRACTOR'S NAME/COMPANY Lic. No. Class IN
Contractors Address L
Contractors E-mail Address
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City State �% �L Zip Telephone �/ ?/7j--
SETBACKS REAR SETBACKS FRONT PERMIT NO. ic2�3 (�77
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PCZOZ,3
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $