HomeMy WebLinkAboutXR2023-1894 - Permit Application1__ Print Form I Worksheet for Combo Building & Solar Permit Application �EWPoRr
r- Comm'I 1--4esidential City of Newport Beach - Building Division s
NOTE: PLAN CHECK FEES DUE AT TIMF nF SI IannITrAI �tr
Kuilding j- Grading F-Drainage f- Elec FMech F- Plum CuYdCut
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Project Address (Not mailing address) C Flood f Fire F- Liq r Landslide F_N/A Floor Suite No
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Description of Work Use F7 Const Type F_
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# Stories # Units (if Res)
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Valuation $ 1
New/Add SF� Remodel SF :�0_5&�' Garage/New/Add � Material/Labor) J pd
OWNER'S NAME Last
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Owner's Address Owner's E-mail Address
City �� U r F- (� State G Zip z t!c� �j Telephone
APPLICANT'S NAME Last I I 1 1 _
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Applicant's Address Applicant's E-mail Address
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City' - State cC(- Zip Fq�(� Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic -�L . No/U✓'kL>� - CO .
Architect/Designer's Address Architect/Designer's E-mail Address
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City �ytcl Ol State C'0..-_- Zip in -_z l Telephone
ENGINEER'S NAME Last I s
First Le 0 Lic.
Engineer's Address Engineer's E-mail Address
City B State q Zip z Z Telephone
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CONTRACTOR'S NAME/COMPANY �� Lic No. !(�SS(ClassFf
Contractor's Address Contractor's E-mail Address
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city oSi ei ell _ state Ccf Zip cl T k7'TTelephone 9 `! g [ Z3.
SETBACKS REAR SETBACKS FRONT PERMIT NO. pIZ'?�6Z� • � �
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1 &?- J • �u (g y
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $