HomeMy WebLinkAboutXR2023-1354 - Permit ApplicationF rnti-Rrrn I Worksheet for Combo -Building & Solar PermitApplicatic lrr ' �y /� 42 WPoR"
(r Comm'I I VResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading f—Drainage r— Elec F_ Mech Plum j�
Cu Yd Cut Cu Yd Fill
Project A dress (Not marling address) 17 Flood j— Fire r Liq f— Landslide F_N/A Floor Suite No
Description of Work G%-A- - A �, �
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At V,9 %ZZ w c /NS «eJ>c. # Stories # Units (if Res)F
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New/Add SFF R e SF Z� Sr Garage/New/Add � Valuation 5 I/ c
- . - Material/Labor !��', `
OWNER'S NAME
Last /�/}n
--G-_ � First
t_.
Owner's Address _
Owner's E-mail Address
City a e
- Zip �— Telephones--
- --- -
APPLICANT'S NAME Last First
Applicant's Address
Appli
cant's E-mail Address
ceiw
city�1 ?f_-'/State 7— Telephone
ARCHITECT/DESIGNER'S NAME Last /7j1 ,q,
/ First V Lic. N - 24 Z ? _
Architect/Designer's Address Architect/Designer's E-mail Address /
-
City �r � Zip TelephoneF�
ENGINEER'S NAME Last
First Lic. No.F_
Engineer's Address Engineer's E-mail Address
City - State Zip �® F- Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No.
F— Class
Contractor's Address Contractor's E-mail Address
State
S
City F--Zip ®� �— Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $