HomeMy WebLinkAboutXC2023-0348 - Permit Application_ Print Form Worksheet for Combo Building & Solar Permit Application a
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City of Newport Beach - Building Division
Comm'I F_ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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r Plum cuYdCut F CuYdFill
Project Address (Not mailing address) F_ Flood F_ Fire r Liq r Landslide r_N/A Floor Suite No
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Description of Work "
WC,
e F—Const Type F_
# Stories #Units (if Res)
New/Add SF�— Remodel SF�— Garage/New/Add F—
Valuation $
Material/Labor Lt
OWNER'S NAME Last fc> ,
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First VA',
Owner's Address
Owner's E-mail Address
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City u� � State C (�
Zip c(26 TelephoneilC( _-3_)4 Cr1431
APPLICANT'S NAME Last
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First uSl.y
Applicant's Address
Applicant's E-mail Address
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Zip G Telephone
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ARCHITECT/DESIGNER'S NAME Last C=^ �..�. .( /�
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First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip TelephoneF—
ENGINEER'S NAME Last
First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F
zip F— Telephoned
CONTRACTOR'S NAME/COMPANY CCsC��Z t5,`S
CY�L Lic. No. tC (,x.2- Class (-_4S
Contractor's Address
Contractors E-mail Address
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City C�1�1 a State I e
Zip `3 �Y Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. w " ✓ — G
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $