HomeMy WebLinkAboutXR2023-0890 - Permit ApplicationPrfntForm Worksheet for Combo Building& Solar Permit Application
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F- Comm'I i- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
F-Building [Grading f-Drainage [Elec Mach Plum Cu vd Cuts Cu Yd Fill _—
Project Address (Not mailing address) C Flood r Fire [- Liq r Landslide CN/A Floor Suite No
Description of Work
Use s Const Type
r eAz4, r
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# Stories # Units (if Resf
Valuation $ ls- J
Material/Labor v Ild /
New/Add SF� Remodel SFF— Garage/New/Add Ir
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State �- Zip Telephone 7! a (O(�
- - - - -
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City ---. _. _..._ ...__.__ State Zip_ Telephones 7_S5_-)G-7L
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ARCHITECT/DESIGNER'S NAME Last L boas First FS, ldlt� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip l Telephone
ENGINEER'S NAME Last First Lic. No.s—
Engineer's Address Engineer's E-mail Address
City State F Zip F Telephone[ —
CONTRACTOR'S NAME/COMPANY 6WtU(np�(/Q� Lic No. l G ,)__l t q3 Class Gj �
U
Contractor's Add s Contractor's E-mail Address
City 1G�(( State Zip QC[O/ Telephone v `3 Qw 3
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $