HomeMy WebLinkAboutXR2023-2063 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage r Elec rx Mech r Plum
roject Address (Not In
3 c) / j 'xsw, it,e
of Work
X/01�11 I./ /Y
New/Add SF r— Remodel SF
OWNER'S NAME Last
Cu Yd Cut I
address) F_ Flood r Fire r Liq r Landslide
Cyry 4) /1,-- Ole e 19k
Garage/New/Add F—
First
Cu Yd Fill
r'N/A Floor
Suite Nc
Use r— Const Type
# StoriesF_ # Units (if Res)F—
Valuation $
Material/Labor W�
___ iii � �
Owner's Address . / LV
/ L / Owner's E-mail Address
City �h�f�7` �4%� State G42JFZi q
P ��� Telephone �O T !�/
ArrLILAN F'S NAME
Applicant's Address
Last
5441'e- - First
Applicant's E-mail Address
City I State
ZiP F� Telephone[�
ARCHITECT/DESIGNER'S NAME
Last First�—
�—
Architect/Designer's Lic. No.Designer's Address Architect/Designer's E-mail Address
City State F— Zip F_ Telephone F�
ENGINEER'S NAME Last
First— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F Zip r� Telephone
CONTRACTOR'S NAME/COMPANY
fl Lic. No. 360 Class
Contractor's Address
Fd
Contractor's E-mail Address
City I State F— Zip t_ Telephoned --
SETBACKS REAR SETBACKS FRONT XR_ of PERMIT NO. G
SETBACKS LEFT SETBACKS RIGHT
USE ZONE --� PLAN CHECK NO. ftj'��i
DEVELOPMENT No