HomeMy WebLinkAboutXR2023-2266 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o °Rr
Comm'I City of Newport Beach - Building Division �i7�2_��
r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1� W Gam'
rBuilding r Grading (—Drainage I—Elec rMech r Plum CuYdCut F CuYdFill s
Project Address (Not mailing address) r Flood r Fire j— Liq F_ Landslide F_N/A Floor Suite No
�,-wz\- ck t, F- F_
Description of Work
Use F—ConstType I
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# Stories # Units (if Res)F_
New/AddSFF RemodelSFF— Garage/New/AddF—
Valuation $ -
Material/Labor �—l6/ �
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City � State �— Zip F— Telephones --
APPLICANT'S NAME Last S N First
Applicant's Address Applicant's E-mail Address
City State F_ Zip F Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F
Architect(Designer's Address Architect/Designer's E-mail Address
City State F_ Zip I TelephoneF_
ENGINEER'S NAME Last 0 First Lic. No.
Engineer's Address Engineers E-mail Address
City State F—Zip Telephoner
CONTRACTOR'S NAME/COMPANY ,vC P CA402o �C re,: c. No. �� 3� Z1 Class
Contractor's Address Contractor's E-mail Address
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City I I I.,(,t FC-fgrVv3 6C- 4C,4"r State F— Zip *Jr6 Lf7 Telephone F 1 p �'_> —T3
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $