HomeMy WebLinkAboutXR2023-2162 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application EWE
TZ- mm'I j—tR6dential City of Newport Beach - Building Division 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r uilding r Grading rDrainage (— Elec r Mech j� j�
I- Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address f Flood
r Fire r— Liq [_ Landslide j—N/A Floor Suite No
of Work GI/ 47/2
New/AddSF�— �Z44T�/�Aji
R�� f'Z Sf Garage/New/Add �—
OWNER' ;NAME
Last First
Owner's Address
Owner's E-maLAi r z
City
APPLICANT'S NAME Last
State �—
No
Applicant's Address
(olz Ai�-_)AIatie- Aye
City ,�L�,M / SL ,�Jxz) State l 7 A'
ARCHITECT/DESIGNER'S NAME
Zip F' Telephone
Use vConstType
# Stories # Units (if Res)W
Valuation $
Material/Laborf_�K/7_/�%� en
First I c%{ Y
Applicant's E-mail Address
/fG��LC`'of/67412— Cay/
Zip c�2 Telephone 9T 7—
Last VZA/ /- _/ First
Architect/Designer's Address
City State r--
ENGINEER'S NAME Last
Engineer's Address
City I State r__
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Architect/Designer's E-mail Address
First
Lic. No ' Z¢ �4G_
Lic. N
Engineer's E-mail Address
Zip r--- TelephoneF�
Lic No. �— ClassF
Contractor's E-mail Address
City I State
Zlp F_ Telephone F�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $