HomeMy WebLinkAboutXR2023-2857 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F^ilding r Grading rDrainage r Elec r' Mech
r Plum Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) I— Flood r Fire F_ Liq r Landslide rN/A Floor Suite No
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Description of Work
Use s ConstType s
# Stories # Units (if Res)s
C/� L I / p /
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Valuation $
Material/Labor / /
New/Add SFs Remodel SF �— Garage/New/Add �—
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OWNER'S NAME Last } rY<, f,
First h y"
Owner's Address
Owner's E-mail Address
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Zip f 75® TelephoneF_
/State
APPLICANT'S NAME Last h f a
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First
Applicant's Address
Applicant's E-mail Address
City IF State G f4
Zip �'l ; , / TelephoneF
ARCHITECT/DESIGNER'S NAME
Last �����,14 First L}}///L'> Lic No. C��yc
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City State �—
Zip I Telephones
ENGINEER'S NAME Last F
First �— Lic. Nol
Engineer's Address
Engineer's E-mail Address
City State �—
Zip Telephone�—
CONTRACTOR'S NAME/COMPANY
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Lic. No. , % j / r Class
Contractor's Address
Contractor's E-mail Address
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City 7 State G'h
Zip 4 Telephone[
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SETBACKS REAR SETBACKS FRONT
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PERMIT NO. xRZM`W w 7
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. P—CU 3.24�sy
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $