HomeMy WebLinkAboutXR2023-1168 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �cf�og
F_ Cori r- Residential City of Newport Beach - Building Division q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'Building r- Grading r-Drainage f5�Elec Ii Mech r(Plum cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) f Flood r- Fire r- Liq r- Landslide r-N/A Floor Suite No
Description of Workf—
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Use W Const Typepew-
# Stories # Units (if Res)FF
Valuation $
Material/Labor I
New/Add SF 1 77A Remodel SFF Garage/New/Add
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OWNER'S NAME Last ��-� rw a ef-m First
Owner's Address Owner's E-mail Address
City-- State Zip Telephoned Z
APPLICANT'S NAME Last �Z First
Applicant's Address Applicant's E-mail Address
City State F— Zip �— Telephone I4 g 51'�%
ARCHITECT/DESIGNER'S NAME Last Y First F Lic. No. ���i G
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F— Zip F Telephone�—
ENGINEER'S NAME Last First— Lic.No.F—
Engineer's Address Engineer's E-mail Address
City State F— Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY J/ Lic No. �— Class
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Contractor's Address Contractor's E-mail Address
City �Ilav*>j O�G State Zip ��pGd Telephone (�/r ). "73-�3
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $