HomeMy WebLinkAboutXR2023-1043 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application Q
r Comm] F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-/building r Grading r—Drainage r Elec r Mech
r Plum CuvdCut F CcYdFill
Project Address (Not mailing address) r— Flood
r F' _ Liq r Landslide F _N/A Floor Suite No
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Description of Work
Use F—ConstType F_
# StoriesF #Units (if Res)
Valuation$ ZC t�G;.—•
Material/Labor
New/AddSFF_ Remodel SFF-- Garage/New/Add
OWNER'S NAME Last I h
First ' A ri I,
Owner's Address
Owner's E-mail Address
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City �.ir.V LA State
Zip q L� ( Z Telephone (,9 4-1 ZA f )
APPLICANT'S NAME Last -} -rr.() '(I C /lj First I l A+ J2_L_A
Applicant's Address
Applicant's E-mail Address
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City State FJkAF
Zip E,&C� Telephone `TFf .1'- ,- 1-4 _3
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City State F—
Zip F_ TelephoneF
ENGINEER'S NAME Last Ci(1--((Z
First Il p i � ^, rO Lic No.FT i z
Engineer's Address
Engineers E-mail Address
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City OP -a State L A-
Zip q Z9t 6 T Telephone l r, Cc{ q -
CONTRACTOR'S NAME/COMPANY i/Ilt�a (Sw; rnyL-TiON Lic. No. t i� ,C.CVj Class j
Contractor's Address
Contractor's E-mail Address
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City Ol�A�(� �7 �_ StateFA
Zip qZ�<, rj Telephone C'�-I•�- }�- 3Pf
SETBACKS REAR SETBACKS FRONT
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PERMIT NO.J(fS (��3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Q cc
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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