HomeMy WebLinkAboutXR2023-1223 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application aw
r Comm'I Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF QUBMITT
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i5LBuilding r Grading rDrainage r Elec r Mech r Plum Cu Yd CutF_ Cu Yd Fill
Project Address (Not mailing address) r Flood i— Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F Const Type F
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# StoriesF # Units (if Res)
Valuation $
Material/Labor 7 SrjO
New/Add SFF— Remodel SF�—
Garage/New/Add F
OWNER'S NAME Last UD1Z
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First
Owner's Address
Owner's E-mail Address
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City ��FF J�„r State F74
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APPLICANT'S NAME Last <
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First 'mot ((r2,L
Applicant's Address
Applicant's E-mail Address
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City V,, 5l State C,4
Zip `72OVS3 Telephone 5Ln-�W-e2ib�5
ARCHITECT/DESIGNER'S NAME Last A1 C:J
L Li//�' fl'G1�0 First C' 6U�'�k/` Lic. No. t? 3Cj c�'rJ
Architect/Designer's Address
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Architect/Designer's E-mail Address
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City 11o1,>7tie_t-4A1 �- State �
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zip
P 22 6 Tele hone F7/c/
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ENGINEER'S NAME Last 61hT/2
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First 7tzOBLBzT0 Lic. No. S_572_
Engineer's Address
Engineer's E-mail Address
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City 6k Alu6— K,*Y State r'' it
Zip ejX R i7 TelephoneF7/t/.-yy7'
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CONTRACTOR'S NAME/COMPANY /t Lic. No. VjJ•2 73 Class
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Contractor's Address
Contractor's E-mail Address
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City I See YrSai� zE State A
Zip ?51 4 o Telephone /Ter�_.57yz _ ` 6-7
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SETBACKS REAR SETBACKS FRONT
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PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. }�CZ(f j� _ I 1
USE ZONE DEVELOPMENT NO
F
PLAN CHECK FEES $