HomeMy WebLinkAboutXR2023-2136 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application e"�''a
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Comm'Iidential City of Newport Beach - Building Division t 'g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-�ilding [- Grading [—Drainage [- Elec [- Mech
[- Plum CuvdCut F_ CuydFill F_
Project Address (Not mailing address) [- Flood
[- Fire [- Liq [- Landslide [-N/A Floor Suite No
Description of Work A Z leP-
Use onst Type Y�
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# StoriesFT # Units (if Res)�/S,
Valuation $ i
Material/Labor � dc
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New/Add SFr— Rehr pdetSFCj 5� Garage/New/Add
OWNER'S NAME Last / ,i/ir- 1 r//i(//e_
9 First
Owner's Address
Owner's E-mail Address
City State �—
Zip F— TelephoneF_—
APPLICANT'S NAME Last A7C
First 0,4 y
Applicant's Address
Applicant's E-mail Address
City /,. d State A
Zip ZC 2 Telephone 7/'W
ARCHITECT/DESIGNER'S/NAME LastIIZ—,4 h /lF
First // CLic h --
Z-S
Architect/Designer's Address
Architect/Designer's E-mail Address
�5&74- A Aar 6 V+
City State
p Telephoned
ENGINEER'S NAME Last �—
First �— Lic. No.r—
Engineer's Address
Engineer's E-mail Address
City State F—
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. F__ ClassF_
Contractor's Address
Contractor's E-mail Address
City I State F_
Zip F— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. F _ V
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $