HomeMy WebLinkAboutXR2023-2420 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�`Aa�
Residential City of Newport Beach - Building Division c
F-Comm'I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °<�.,NN',
rBuilding r Grading
F-Drainage F Elec I—Mech r Plum CuYdCut s CuYdFill �
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide r_N/A Floor Suite No
F_ F_
Description of Work
Uses ConstType r—
# Storiess # Units (if Res)s
Vom
New/Add SF
Remodel SF
rage/New/Add �—
Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State �— Zip Telephoned
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State I—
Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
ArchitecVDesigner's Address
Architect/Designer's E-mail Address
City
State F—
Zip F_ Telephoned
ENGINEER'S NAME
Last �—
First Lic. No.1
Engineer's Address
Engineers E-mail Address
City �—
State F—
Zip F_ Telephones
CONTRACTOR'S NAME/COMPANY PAL, K I� .rt CZ C �L S c Lic. No, IU 1�67 �_ Class
Contractor's Address 1 .�
(�� vv 5 Contractor's E-mail Address
S�.tes P �bst.eZeLo,vw.�5c,LPc.c—
City f t , �_E
State �A
Zip is b c(r-( Telephone �71-41lj 71 _U
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO)
USE ZONE
DEVELOPMENT NO
PLAN CHECK FIRS,
Xr Zoz 3 -Z-a 2u