HomeMy WebLinkAboutXC2023-0035 - Permit ApplicationI, irbl
Print Form Wcrksheet for Combo Building & Solar Permit Application
Comm'I ❑Residential City of Newport Beach -Building Division C
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide FJN/A Floor Suite No
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Description of Work
Use p t' ons[Type
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# Stories It Units (if Ress
Valuation$
Material/Labor l t7! f
New/Add SF � �I Remodel SF Z� �, I Garage/New/Add �
OWNER'S NAME Last �'yi�k, First
Owners Address Owners E-mail Address
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City vRVLd E— _ J State Zip Telephone
APPLICANT'S NAME Last ` `� First
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Applicant's Address Applicant's E-mail Address
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City State ZipLqli�&71 Telephone 1• - —�
ARCHITECT/DESIGNER'S NAME ,/ t��
Las[ i"l���N� I First GI� I U[.No.
ArchitecdDesigners Address Architect/Designers E-mail Address
City �Zi /— State C�/ � zip ' 2, v Telephone + �p G11
ENGINEER'S NAME-) Last First Lic No.�-1
Engineers Address Engineers E-mail Address - -
City State i Zip Telephone 1
CONTRACTOR'S NAME/COMPANY �� Q�i P1j I Lic No.W(,3bg I Class
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Contractors Address ICI c C tractors E-mail Address
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City �tr�J Pam-; 3�E�e State FCst Zip_�zb60i Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �L z'i _ C)T(,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $