HomeMy WebLinkAboutXR2023-2783 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j"- Comm" Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building [- Grading [—Drainage VElec [-Meth
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Project Address (Not mailing address) [- Flood
[- Fire [- Liq [- Landslide [-N/A Floor Suite No
Description of Work
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# Stories #Units (if Res)
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Valuation $
Material/Labor
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OWNER'S NAME Last[
First
Owner's Address
Owner's E-mail Address
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City tit WI� State
Zip (j'� TelephoneF 40 —�C 3
APPLICANT'S NAME Last Pn� CJ�
First 9�2$j:51L) -
Applicant's Address
Applicant's E-mail Address
City State I OA
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Zip Telephone � lI 114 '2.Z 7 v?
ARCHITECT/DESIGNER'S NAME Last �z L First F�
Lic. No.
ArchitecdDesigner's Address
Architect/Designer's E-mail Address
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City I "J State /�
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Zip Telephone /�(G—(D—
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ENGINEER'S NAME Last
First F— Lic. No.F
Engineers Address
Engineer's E-mail Address
City State F_
Zip �— TelephoneF_
CONTRACTOR'SNAMElCOMPANY /t �V
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r,�} ( •rLic. No. KI(pb(�� Class
Contractor's Address
Contractors E-mail Address
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City t,(�pt,�nState
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Zip Telephone {�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Z�9
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. C-U i,T J 1
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $