HomeMy WebLinkAboutXC2023-0478 - Permit ApplicationPrint Form
Comm'I F
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading F-Drainage r(!LIe% %Meth'' rim Cu vd Cut Cu Yd Fill FdDing
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F Const Type
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# Stories # Units (if Res)F
Valuation
Material/Laa bor
1 s
New/Add SF Remodel SF �.��— Garage/New/Add
OWNER'S NAME Last I
PA 01'4fi A f�A tv First A t !:
Owner's Address
Owner's E-mail Address
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City 1 CU! ry
State Zip F Telephone /l� ��/ 8 -• /��6d
APPLICANT'S NAME Last
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Applicant's
Applicant's E-mail Address
,Address
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City / .�-
State — Zip 9i�.w Telephone 1?W 7
ARCHITECT/DESIGNER'S NAME
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Last �,,F� l �l ���� First .. c� Lit No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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C% City � 0ST4 /nc574
State F _n4 Zip �,j Telephone `%/yf-G(,g- Va1'6O
ENGINEER'S NAME Last
� First F_ Lic. No.F_
Engineers Address
Engineer's E-mail Address
City
State F_ Zip I v Telephoned
CONTRACTOR'S NAME/COMPANY
Ulwr� f � � is cPrPl�Lkci�Z Lic. No.
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Contractor's Address
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Contractor's E-mail Address
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City �qA�F 019�'CJ1-
State (?�--. Zip yd/F. Telephone �/fg-3 `/-QJ�/o
SETBACKS REAR
OF
SETBACKS FRONT PERMIT NO c WW • D 16
SETBACKS LEFT
SETBACKS RIGHT PLANCHECKNO�
USE ZONE
DEVELOPMENT NO �PVI ES S