HomeMy WebLinkAboutXR2023-1433 - Permit Application__!Print Forn I
_ / Worksheet forCombo ding & Solar Permit Application (15_,W)e
I Comm'I (VResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading j—Drainage r Elec Mech j�
�PIUm Cu Yd Cutl Cu Yd Filll
Project Address (Not mailing address) [ Flood 71 r" Fire r Liq F7 Landslide F_N/A Floor Suite No
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Description of Work
%ZlCt✓rQ'y /T�t O /Zrj'</tCFc h/ / ' �� 2Q Use G:ConstTypeI ,f2
1A �'L ��fi/- �ti �i.L n� � � #Stories #Units (if Res)
New/Add SF�— / GarageNew/Add model SF 6f �f F— Valuation a
- Material/Labor ��•
OWNER'S NAME Last 1/274'jj( First
Owner's Address
City
State �— Zip f Telephone�—
APPLICANTS NAME Last (/ d tC
First
Applicant's Address
C Applicant's E-mail Address
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City �� fl ✓/�x7a q
�-� ' �I,t) State L Zip 7%1 Z Telephone
ARCHITECT/DESIGNER'S NAME
Last 12AXl ; First TAAJ y> Lic. NF
Architect/Designees Address Architect/Designer's E-mail Address
City
- ZIP ��`---Telephone
F�
ENGINEER'S NAME Last
First F � Lic. No,
Engineer's Address Engineer's E-mail Address
City State
ZIP Telephoner
CONTRACTOR'S NAME/COMPANY ` Class rq--_ Lic No. yj(s�D�
Contractor's Address
City State F— --
Zip
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE DEVELOPMENT NO
Contractor's E-mail Address
TelephoneF�
PERMIT NO.
PLAN CHECK NO,
PLAN CHECK FEES $