HomeMy WebLinkAboutXR2023-1347 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application SRr Comm] Residential City of Newport Beach - Building Division
NOTE PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading (-Drainage r Elec r Mech j- Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) r Flood r Firer Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F—ConstType
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# Stories # Units (if Res)[—
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Valuation $
Material/Labor
New/Add SF ZC� S t ,, Remodel SF F Garage/New/Add Ir
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City State I Zip F— Telephon [t+C( 7y-I j _)jq C%
APPLICANT'S NAME Last FZ: �7vj First �k
Applicant's Address Applicant's E-mail Address
City n� dyLA State Zip Z bV Telephone Cje �) �1-37
ARCHITECT/DESIGNER'S NAME Last c �lMe . 5 p_ p j,c rtn-'t First F_
� q � Lic. No.
ArchitectIDesigner's Address Architect/Designees E-mail Address
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City F State F_ Zip F_ Telephoned
ENGINEER'S NAME Last ,VL\UCH First S{> *a�!� Lic.No.r_
Engineer's Address Engineer's E-mail Address
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City t �/ ` t u,M State c; Zip `?2 8 0.7 Telephone
CONTRACTOR'S NAME/COMPANY 1 ; t' S[%N r 3 1uc ' my tj Lic No. �— Class s—
Contractor's Address Cojntractor's E-mail Address
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City t,lZ i�L,� State Cry- Zip 1 Telephone C l y-) 225 6 �j
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $