HomeMy WebLinkAboutXR2023-0857 - Permit ApplicationPrint Form ) Worksheet for Combo Building & Solar Permit Application o�EW�ga
F_ Comm'I r Residential City of Newport Beach - Building Division X�2vz3 �bg�7 L N NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building [Grading F-Drainage F-Elec F-Mech F-PlumCu Yd Cut Cu Yd Fill
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Project Address (Not mailing address) C Flood F- Fire j- Liq F- Landslide CN/A Floor Suite No
S C(n4V1�6ct
Description of Work
Use F— Const Type
w
# Stories # Units (if Res)F—
Valuation $
Material/Labor t I aC
New/Add SFF — Remodel SFF Garage/New/Add �—
OWNER'S NAME Last �� ��� First r(1aYhw
Owner's Address Owner's E-mail Address
City State f Zip Telephone —
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
-------------- - -- - — - -------
City State Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME Last First F — — — Lic. No. F—
Architect/Designer's Address Architect/Designees E-mail Address
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City State —ZIP r Telephoned
ENGINEER'S NAME Last First F� Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. i (5 Class
r`1wAln drier So�a�
- yy — -
J_
Contractor's Address Contractor's E-mail Address
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City Ce�rt��S
State ZipqOr�E)3 TelephorieF:;;�
S C)
SETBACKS REAR SETBACKS FRONT PERMIT NO. 7V� r CJ�/S —0 ` 1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.t PGZrJ7i� —0 %
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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