HomeMy WebLinkAboutXR2023-2489 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
nInTr- ci AN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building F_Gradingr-Drainage F-Elec rMech FPlum CuYdCut F cuvdRIF
Project Address (Not mailing address) Flood r Fire r Liq F_ Landslide f N/A Floor Suite No
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Description of Work
Use �_ ConstType F_
# Stories # Units (if Res)F—
Valuation S I j� �D it
Mate ial/Labor C/
Gar1age/New/Add I
New/Add SF�- Remodel SF�—
OWNER'S NAME Last N �WPOCZ`C �YSt 1 First
Owner's -Addy frrtMbkddre
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City State �r/f� Zip qj 6� Telephoner
APPLICANT'S NAME Last (T14 First FNkkz(dS
Applicants Address Applicants E-mail Address
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City State I !^ (1 Zip I 9 9.�7 Telephonel'�'
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ARCHITECTIDESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address ArchitecNDesigner's E-mail Address
City State I Zip I Telephone
ENGINEER'S NAME Last X i R D First � t Lic. No. S
Engineer's Address Engineer's E-mail Address
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City Grp �� �Nr� State n Zip q�n b� Telephone! „� �G 2 osr zy
CONTRACTOR'S NAME/COMPANY . /. . 5� M i-r� CDN�� Lic. No. Classl�-
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Contractor's Address Contractors E-mail Address
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Ci R�[(A kw- State G� Zip C%� Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. Jr RI - Z4 8 `
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $