HomeMy WebLinkAboutXR2023-0016 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 0FCE6o°oPo
F-Comm'I [>�F eesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Q�u ding F_ Grading rDrainage (-Elec F_Mech F- Plum CuvdCut l CuYdFill
Project Address (Not mailing address) i- Flood r Fire F_ Liq r Landslide F-N/A Floor Suite No
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Description of Work
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se F—ConstType
EDEMULMUO OF /� /JD LRZ L'
# StoriesF— # Units (if Res)F—
Valuation $
New/Add SFF_ Remodel SFGarage/New/Add
Material/Labor F( L'C'U
OWNER'S NAME Last First L /
Owners Address Owner's E-mail Address
F'JC C_X/,�j> T�U �7[ O
City `�, State Zip `�2/ — Telephone l/l{ 34� -�7/'b
APPLICANT'S NAME Lash First/Z/ 2-
Applicant's Address Applicant's E-mail Address
City State Zip F_ Telephoner
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephoned
ENGINEER'S NAME Last First F_ Lic. No.F_
Engineers Address Engineer's E-mail Address
City State 7— Zip F_ Telephone7—
CONTRACTOR'S NAMEICOMPANY r1� ` Lic. No. Class
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Contractor's Address Contractor's E-mail Address
t27 A b ii Eu�°>&P/G�AP-H&x ,,L7 T2L-)e-!/(ok,. 1L)IG%
City P, State Zip 1 9121,6L Telephone 714% -_�43 f7L?67
SETBACKS REAR SETBACKS FRONT PERMIT NO. X (Z, ZeZ_5 - (5( 1 G
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO ('Cz70 Zz - Q 10S 7 PLAN CHECK FEES $