HomeMy WebLinkAboutXR2023-0930 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application o4jj °gym
Comm" j Residential City of Newport Beach - Building Division 5u
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F- Building r Grading
F-Drainage r- Elec r Mech
r Plum Cuvdcutr CuYdFill F
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
Use I _y� Const Type UB
K.)+L �z
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# StoriesF # Units (if Res)[—
Valuati $r 1rNew/AddSF
Mated �IO
,
� Remodel Garage/New/Add
OWNER'S NAME
Last M A W' 1 1 N
First i CU C. C
Owner's Address
Owner's E-mail Address
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1 1u-)110 R (uo' r -fie.
City �i�:1rl�l.iC�.�
tn-;,t. �A State
Telephone p7((q I IIG1
APPLICANT'S NAME
Last �� 1 1�
First I N I CO b E
Applicant's Address
Applicant's E-mail Address
City
State F_
Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No.
Architect/Designer's Address
ArchitectIDesigner's E-mail Address
City
State F_
Zip F_ Telephoned
ENGINEER'S NAME
Last
First F Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip Telephone�—
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City
State F_
Zip F_ TelephoneF—
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. XX
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
PLAN CHECK No. t/ /c�/J-
k�� 74Z5
DEVELOPMENT NO
PLAN CHECK FEES $
01,