HomeMy WebLinkAboutXR2023-0122 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F- Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
B,VNuilding Grading Drainage �Elec �Mech Plum Cu vd Cut Cu Yd Fill s
Project Address (Not mailing address) 7_ Flood F_ Fire F_ Liq 1- Landslide F_N/A Floor Suite No
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Description of Work
Use � ConstType
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# Stories # Units (if Res)s
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Valuation $ t
Material/Labor
New/Add SFF— Remodel SFF—
Garage/New/Add �—
OWNER'S NAME Last I SIN; I C--,ti l -Rd t12,5_`= First
Owner's Address
Owner's E-mail Address
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City �LOecNA 5�� i7Z]�� State 6,1 Zip TelephoneF7777777
APPLICANT'S NAME Last v y ira-C
First I`ri"�t.,
Applicant's Address
Applicant's E-mail Address
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City I eKt{r LF State �-
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Zip `YZ o (Z Telephone - /q '7f 2 y8c
ARCHITECT/DESIGNER'S NAME Last
First
Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
ZIP �- Telephones --
ENGINEER'S NAME Last F First Lic. No. 3r<!v'7
Engineer's Address
Engineer's E-mail Address
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City _51/ f}�>A State CA
Zip 927cI Telephone 7/� i3S- zEi!"7
CONTRACTOR'S NAME/COMPANY c Lic No. j7ot1,; Class C-Zy
Contractor's Address
Contractor's E-mail Address
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T>o 6,VA-4,6
City CH State Cfi
Zip %266l Telephone --y/c/ '7gz
SETBACKS REAR SETBACKS FRONT
PERMIT NO. /; Ie f,*zd -rl�?2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK (mil
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