HomeMy WebLinkAboutXR2023-3272 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application °zEWP°.e
F_ Comm'I F_ Residential City of Newport Beach - Building Division ti =
NOTE: PLAN CHECK FEES DUE AT TIME OF SHRMITTAI
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Project Address (Plot mailing address) r- Flood r" Fire F- Liq r Landslide ( N/A Floor Suite No
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Description of Work
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Stories[ # Units (if Res)F-
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Valuation $ I
Material/Labor I lq , o u U
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New/Add SF �— Remodel SF F 2CGarage/New/Add 1"'�
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OWNER'S NAME Last Flap j'�/�
Owner's Address Owner's E-mail Address
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City Q State ICA Zip /Jl Telephone q q_
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APPLICANT'S NAME Last I O(- First
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Applicant's Address Applicant's E-mail Address
City State �— Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip I— TelephoneF—
ENGINEER'S NAME Last First F— Lic. No f —
Engineer's Address Engineer's E-mail Address
City �— State F_ Zip FJ TelephoneF_
CONTRACTOR'S NAME/COMPANY C� � j, U Lic. No. ?�-Classl_--
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Contractor's Address Contractor's E-mail Address
U bO4 E, La Palm( Am lit\d6i e- ca.rPd(sgv.cant
City {Xyt�1) 'm State /t Zip i� Z�—Q' - Telephone 7 �� _ q�/- 133 �{
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SETBACKS REAR SETBACKS FRONT PERMIT NO, ?r0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ft
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $