HomeMy WebLinkAboutXR2023-1388 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application o�EW�ae
r Comm'I sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
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F_ Building F_ Grading rDrainage KElec Kmech 'Plum CuvdCut [-- CuYdFill F_
Project Address (Not mailing
address) F_ Flood f Fire r Liq r Landslide f N/A Floor Suite No
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Description Work
Use F—Const Type F
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# Stories Units(if Res)
Valuation $ / �^
Material/Labor I �f �bi�
New/Add SF �U Remodel SF g
lw Garae/New/Add
OWNER'S NAME Last
First 13 Y—t
Owner's Address
Owner's E-mail Address
ub f%
City New ^' 1 (� .�G0 State Zip / f Telephone
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APPLICANT'S NAME Last
� �yQ� Fiurssttl grr�er
Applicant's Address
Applicant's E-mail Address
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City
State �- zipF TeleP hone -'-"—
ARCHITECT/DESIGNER'S NAME
Last S n_ effcr First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
31 q U Itap r5i
Rve, If �0 0) of 010s ( 2 S, Y) 5.�hca
City :Pro o rL(
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State I V"Zip � ��- Telephone , �� 0q_ 33 �
ENGINEER'S NAME Last
First Lic. No.F—
Engineer's Address
Engineers E-mail Address
City
State �— ZipF Telephoned
CONTRACTOR'S NAM ElCOMPANY
trnC�7 -lietttk3 /f�G Lic. No. F4;iF&/IF Class �
Contractor's Address
Contractor's E-mail Address
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rnCity
jX'nState
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�—Zip Telephone 9 -336 3
SETBACKS REAR
SETBACKS FRONT PERMIT NO. R, d� Cw'�22J" On
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. Pr d��(�✓' J
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $