HomeMy WebLinkAboutXR2023-2715 - Permit ApplicationPrint Form - Worksheet for Combo Building & Solar Permit Application oF� °Y
CFv/romm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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uilding F_ Grading F-Drainage F-Elec F-Mech
F-Plum Cu Yd cut[_ Cu Yd Fill F_
Project Address (Not mailing address) F-Vt-lood
r Fire r Liq F` Landslide F_N/AAFloorSuite No
66 51 I r 0
Description of Work
Use F_ Const Type F_
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Valuation $
Material/Labor / q�
New/Add SF� Remodel SF Garage/New/Add F—
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OWNER'SNAME Last �Zf bt�
First F*va ,1)
Owner's AddressC
Owner's E-mail Address
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ZiP Telephone. 2y�
APPLICANT'S NAME Last 1 . \ O Ij rQ, VV
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First 7 tH
Applicant's Address
Applicant's E-mail Address
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Cit �t StateFC
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I Tele hone
ZIP `L 6L(L p-37-?OSZ
ARCHITECT/DESIGNER'S NAME Last First F—
Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City State F_
Zip F_ Telephoned
ENGINEER'S NAME Last
First Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City State �—
Zip �- Telephoned
CONTRACTOR'S NAME/COMPANY Sl gria _ ��5 f arQ j�✓L Lic. No. 9 Classy
Contractor's Address
Contractor's E-mail Address
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City Arden YLv4/ State
Zip 2g�(j Telephone �J4/-"73-3-7osZ
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.