HomeMy WebLinkAboutXC2023-0335 - Permit ApplicationPrint Form_ WWorksheet for Combo wilding & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE, PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building jJ Grading (—Drainage Elec XMech
Plum Cu Yd Cut Cu Yd FlllF
Project Address (Not mailing address) Flood
r Fire F_ Litt F Landslide FN/A Floor Suite No
Description of Work
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#Stories #Units (if Res
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New/Add SF� Remodel SF� (f ?i Garage/New/Add
Valuation $ ' Z/l O�,/
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91UNFR'S NAME Last '�^I 1 "'G �'-��jJl�i l% - _ First —
Owners Address
Owner's E-mail Address
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Zip �� L. (✓''7 Telephone�� 4�l:. ZU
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APPLICANT'S NAME Last �l J
First
Applicant's Address
Applicant's E-mail Address
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City State C
Zip q_1 � '1 Telephone -Z'� -'1 � - L K/
ARCHITECT/DESIGNER'S NAME Last ��hl _fir 7 First �u Lic. No. L f 1 �I ,
ArchitecUDesigners Address ,
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Architect/Designers E-mail Address
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City (�I=1tV?G /�� p�/'`�1 State/^.
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Zip �' �'L" Telephone
ENGINEER'S NAME Last
First Lic. No.�—
Engineers Address
Engineer's E-mail Address
I City State
Zip TelephoneF—
CONTRACTOn'S NAME/COMPANY F_
Lic No, F Class
Contractor's Address
Contractors E-mail Address
City State F—
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
- PERMIT NO. XG2OV/ • D ,iy
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. oZ°J
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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