HomeMy WebLinkAboutXR2023-2285 - Permit Application' Print Form I Worksheet for Combo Building & Solar Permit Application cl%
r Comm'I j� Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building rGrading rDrainage r-Elec r'Mech
rPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I- Flood
r Fire I- Liq r Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type I
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F,
IF Stories #Units (if Res)
„-ttN 61
New/Add SF F RemodelSFF Garage/New/Add —
Valuation$
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State
Zip F TelephoneF_
PPLICANT'S NAME Last I W A d <7
First
Applicant's Address
Applicant's E-mail Address
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City f`1 . �, / 1 7-(Q0tate l/ti
Zip I Z 1CJGj Telephone 11q' �d� • cj�j;LJ
ARCHITECT/DESIGNER'S NAME
h�Yu1 � �� f'c�l�t a N..�
First Lic No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �
Zip F Telephone�—
ENGINEER'S NAME Last I
First 7— Lic. No.F—
Engineers Address
Engineer's E-mail Address
City I State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- Class
�IOS�
Contractor's Address
Contractor's E-mail Address
City State F--
Zip I Telephoned
�W? -2,10 2�
SETBACKS REAR SETBACKS FRONT
PERMIT N( 'i` 1 �^
SETBACKS LEFT SETBACKS RIGHT
r�(12�-7'
PLAN CHECK NO. X eA00?,/uLgj 1!�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $