HomeMy WebLinkAboutXC2023-0109 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit rpplication ��EW�
F_ Comm'I F_ Residential City of Newport Beach - Building Divisiono
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.�.r"
F- Building r Grading rDrainage r Elec r Mech r Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
a) - 1 Vi•;tL kidee Pam(. � I-
Description of Work
Use F—Const Type F
# StoriesF_ # Units (if Res)F_
New/AddSFF_ Remodel SFF—Garage/New/AddF—
Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owners E-mail Address
City
State I— zip F_ Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F— Zip TelephoneF
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F Telephone
ENGINEER'S NAME Last
First F_ Lic. No.F—
Engineers Address
Engineer's E-mail Address
City
State F Zip F_ Telephone
CONTRACTOR'S NAMEICOMPANY
(/� hn � M L C f J( Lic. No. 13,%3 Class U/C
Contractor's Address
Contractor's E-mail Address
(1W5
U,e-fiPL,.lt)rm �K3C0r Aef
city 5 0. Sprlor S
State I zip (AD 61D Tele hone
SETBACKS REAR
SETBACKS FRONTI PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. PG Z01,3 - O$ O "I
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $