HomeMy WebLinkAboutXR2023-2860 - Permit ApplicationPrint Form I Worksheet for
F Comm'] F Residential
NOTE
Combo Building & Solar Permit Application
City of Newport Beach - Building Division
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL \\
F_Building j- Grading F-Drainage r Elec r Mech F- Plum cuvdCut s cuYdFiu s
Project Address (Not mailing address) F Flood F Fire r Liq r Landslide (—N/A Floor Suite No
Description of Work
Use ConstType s
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# Stories N Units (if Res)j
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Valuationa
Material/Labor
New/AddSFs RemodelSFs Garage/New/Add—
OWNER'S NAME Last 2e1j— First
Owner's Address Owner's E-mail Address
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City , ^ �>�{ State I Zip C,'�66iq Telephone ell 7 \1
APPLICANT'S NAME Last (9First I UC
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Applicant's Address Applicant's E-mail Address
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City n J'P-5 State �/� Zip - Telephone q�-06 t-
ARCHITECT/DESIGNER'S NAME Last FJ First F_ Lic. No. F-0
Architect/Designer's Address Architect/Designer's E-mail Address
City State f _ Zip TelephoneF—
ENGINEER'S NAME Last (C O p Z e \ First �2 ✓( Lic. No.
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Engineer's Address Engineer's E-mail Address
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City I ?/(, CC VA e., State G' .— Zip TelephoneFT Y T-7
CONTRACTOR'S NAME/COMPANY —j LJ 5 C c p re Lic No. oclassF
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Contractor's Address C'ontractor's E-mail Address
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city State C0�— ZipFC,_i(_ GT Telephonel__
SETBACKS REAR SETBACKS FRONT PERMIT NO. -
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $