HomeMy WebLinkAboutXR2023-2285 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I JA Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building / )Grading F-Drainage Elec �ech z Plum CuvdCut � cuvdFill
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq r Landslide F_N/A Floor Suite No
22W �?AUFt c D (?. F F---
New/Add SFFa� Remodel SF �Garage/New/Add
Use s ConstType s
# StoriesF_ # Units (if Res)[_
Valuation $
Material/Labor
OWNER'S NAME Last A� First �E +
Owner's Address Owner's E-mail Address
'L2lla �i�C�f1C 176�
City NEWF:b2 aEAc Ei State CA Zip q'L(DZGj Telephones
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F_ Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last First 1I N0 Lic. No UGM
Architect/Designer's Address Architect/Designees E-mail Address
City iZW baf �)SEAV\ State F5 Zip 11'j�(.J0 Telephone y6ifD1-%�45
ENGINEER'S NAME Last First F_ Lic. No.s
Engineer's Address Engineer's E-mail Address
City State F_ Zip F__ TelephoneF-
CONTRACTOR'S NAME/COMPANYkS,� �AMu Lic. No. ;�i �--) Class
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Contractor's Address Contractor's E-mail Address
SbQ t�ctk. Su SL �t76U 4py� glh�LtotMcs: COl^,
City _ � State C./7 Zip :) [_U Telephone �_),y- iS3e/
3E BACKS REAR SETBACKS FRONT PERMIT NO. �Ol
S BACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $