HomeMy WebLinkAboutXR2023-3211 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application &P,
Comm'I r- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding r Grading F-Drainage F_ Elec r Mech
r Plum CuYdCut F CuYdFill
Project Address (Not mailing address) F Flood
F_ Fire F_ Liq F_ Landslide FN/A Floor Suite No
5d!q 3 EA S h0a C- D2
Description of Work
Use s ConstType s
/
P\r--I,F�NI��AIL
#Stories[ # Units (if Res) �
New/Add SF Remodel SF �— Garage/New/Add
Valuation $
Material/Labor FQo
I
OWNER'S NAME Last I MC L A U (e H L I Iv
First I f2 Dt0 A9-D -
Owner's Address
Owner's E-mail Address
SAN( 5" -e- D a-
�ule�lc�a
city �ICU�1�02� State C�
Zip ��(�J Tr1ehone _722-IQy3
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City �— State I—
Zip F Telephones—
ARCHITECT/DESIGNER'S NAME Last First ry--- Lic. No. �4
Architect/Designer's Address
Architect/Designer's E-mail Address
City State I.-----
Zip Telephone
ENGINEER'S NAME Last
First Lic. No.1
Engineers Address
Engineer's E-mail Address
City State
Zip s�u Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. Class F
Contractor's Address
Contractor's E-mail Address
City State r --
Zip I TelephoneF—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.U�V' ✓
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $