HomeMy WebLinkAboutXR2023-0132 - Permit Application(__Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Drainage _ Elec Vmech 7 lum Cu Yd Cut[_ Cu Yd Fill
Project Address (Not mailing address) F_ Flood F_ Fire f- Liq Landslide CN/A Floor Suite No
220 Ca_
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Description of Work
Use F— Const Type
# Stories # Units (if Res)s
New/Add SFE
--
Remodel SF Garage/New/Add �—
i
— —
Valuation $
Material/Labor
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City j�f iw
State I �" ZIP q Z }' Telephones--
APPLICANT'S
LICANT'S NAME
Last Ana _11 q� r - First cf '0� -
Applicant's Address
licant's E-mail Address
Applicant's
City
State Zip Telephone ��-( 558
ARCHITECT/DESIGNER'S NAME Last First Lic No. 2 SC_ ( 7 6
Architect/Designer's Address
Architect/Designer's E-mail Address
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City
State �— Zip TelephoneF—
ENGINEER'S NAME
Last Firsts® Lic. No.
Engineers Address
Engineer's E-mail Address
City State F—Zip r__— Telephones—
ACTOR'S NAME/COMPANY 11 Q Lic. No. y b. 3(xlasss
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Crntractors
C Address
Contractor's E-mail Address
01) _VuI
an p e�
City U (� N AlS
State CF Zip ! I N Telephone Bl
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. PC 20Z3 "t�I J0
USE ZONE
DEVELOPMENT NO W2 3-C� Z� PLAN CHECK FEES $