HomeMy WebLinkAboutXR2023-3321 - Permit ApplicationPrint Form I Worksheet for
- Comm] Residential
NOTE
Combo Building & Solar PermiML,
ication rEwPip
City of Newport Beach - Building Division MITTPLAN CHECK FEES DUE AT TIME OF SUB
(Building r Grading F-Drainage �%Elec F Mech
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Plum CuYdCut CuYdFill F�
Project Address (Not mailing address) F Flood
F Fire r Liq (- Landslide f N/A Floor Suite No
Description of Work
Use s Const Type s
# Stories # Units (if Resf
Valuation $
Material/Labor
rT r r
araga/New/AddNew/Add SF Remodel SF
OWNER'S NAME Last 73pt t, MN
First
Owner's Address
Owner's E-mail Address
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ma's 'RQt
City I:L {t , �G'� State \\!iyL
Zip FqWj_c)- Telephon ��-) 3
APPLICANT'S NAME Last 7Ki\h\
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First
Applicant's Address
Applicant's E-mail Address
City State (N
Zip 9 Telephon �l�V+ �-nz-,-y-i
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ARCHITECT/DESIGNER'S NAME Last
Lic . NoFirst �
No.F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F— Telephones —
ENGINEER'S NAME Last d�
First � -Skj 6 nJ Lic No.F—
Engineer's Address
Engineer's E-mail Address
�qN �^ 1 &&L
City CT 5;-r%Q State (
v
Zip q/ t Telepho I�L1(% t,.I48S Wr'l
CONTRACTOR'S NAIVE/COMPANY
Lic �— No. ClassF_
Contractor's Address
Contractors E-mail Address
City I- State F—
Zip F_ Telephones
SETBACKS REAR SETBACKS FRONT
PERMIT NO. OZ 33 2,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �Z►7 • ZB�I "
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ T