HomeMy WebLinkAboutXR2023-1920 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ."
Building r Grading rDrainage >�Elec i-Mech r Plum CuYdCut CuvdFill
Project Address (Not mailing address) r Flood r Fire j- Liq r Landslide r_N/A Floor Suite No
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Description of Work
Use F—ConstType
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# riesF_ #Units (if Res)
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Valuation $
Material/La r T (J
New/AddSFF_ Remodel SF Garage/New/Add
OWNER'S NAME Last I, First
Owner's Address 11�
� Cola- - Owner's E-mail Address
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City State Zip Telephone � Lt� "q 7(j6 /� 5-4 �
APPLICANT'S NAME Last 5r:. f�/L,n tL� First CFn
Applicant's A,ddrenss_ Applicant's E-mail Address
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city State ;✓r,'�N ��lIGEF State G/a-- ZiP 'Z� t(% Telephone '7 -u .��3 `Y
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ARCHITECT/DESIGNER'S NAME Last n� q First /� & Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City 0 -�/ (�/�+JUJ State ' Zip FIT, b07 Telephone�—
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ENGINEER'S NAME Last O\ c L� v_k b First [ -c S Lic. No. �—
Engineer's Address Engineer's E-mail Address 7$ k Z 7
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City �— State F— Zip F_ Telephoned
CONTRACTOR'SNAME/COMPANY ` ,y-�L Lic No. F,�_I�Z7Clas nj
Contractor's Address L
Contractor's E-mail Address
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City `-(ct'^7Z�0Z;'�N StateFE� Zip Telephone 'Z�jC:j 'l
SETBACKS REAR SETBACKS FRONT PERMIT NO. ,p ; 1 i ` D
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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