HomeMy WebLinkAboutXR2023-2778 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
O Building ) Grading vpDrainage A Elec
Project Address (Not mailing addrei
Description of Work
New/Add SF 1 408— Remodel SF
OWNER'S NAME Last
XMech %,9 Plum Cu Yd Cut
F- Flood r Fire r Liq r Landslide
Cu Yd Fill
F_N/A Floor Suite No
Use r'T ConstType �/$
�Storieslii__ # Units (if Res)T
Valuation $ /f,�
Garage/New/Add — Material/Labor
First
Owner's Address Owner's E-mail Address
City N_1 w*r*J rr State I tT Zip i(j6 Telephone Cr4q.0344. nql
APPLICANT'S NAME Last I!/First I
Applicant's Address Applicant's E-mail Address
City State Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME Last Z First Lic. No.31
ArchitecUDesigner's Address Architect/Designer's E-mail Address
510 L'w's R A1la, (IvAL21 Li0c mA-iu.cveA
City C&-ONATVEL, M& L State Zip F0rL&?.0!;' Telephone ft iV�42
ENGINEER'S NAME Last X First QI Lic. No. S�
Engineer's Address Engineer's E-mail Address
1 '�U fJP4 1$U_oW
City 60 f " State FX— Zip 1 4 Telephone ��• �`Z ��I
CONTRACTOR'S NAME/COMPANY Lic. No. Class
I"ontractor's Address
City
!SETBACKS REAR
SETBACKS LEFT
USE ZONE
Contractor's E-mail Address
State F_ Zip I— Telephoned
SETBACKS FRONT PERMIT NO. /l.Q7i • Z'T1
SETBACKS RIGHT PLAN CHECK NO. e�2�• L-`42�
DEVELOPMENT NO
PLAN CHECK FEES $