HomeMy WebLinkAboutXR2023-1642 - Permit Applicationik ont Form I Worksheet for Combo Building & Solar Perm' _ lication 1AM,
r— Comm'I Residential City of Newport Beach - Building Division(11
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI 5,.._..•
jy4guilding r Grading rainage r Elec (— Mech
r Plum cuvdCut F_ CuYdFill s
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use ConstType s
# Stories # Units (if Res)s
Valuation
Material/Labor
New/Add SFJ Remodel SF'7 Garage/New/Add F—
OWNER'S NAME Last IF, First
Owner's Address
Owner's E-mail Address
City ` i���/ State �—
r State
ZipS'T Telephone
I /c—Fiirrst
APPLICANT'S NAME
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Applicant's Address
Applicant's E-mail Address
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l�•' /%�� State �n�
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last j�<�jv First J��I�/il Lic. No. cam/ U r$
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Architect/Designer's Address
Architect/Designees E-mail Address
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Id o16-1s��G�d.�7
City %7(1/1x-7 State h" i
Zip 2&12_ Telephone-1
ENGINEER'S NAME Last 1/��%/
First W7410 Lic. No. czaJyG/
Engineer's Address
Engineers E-mail Address
City , ,✓//�;;.� State
ZipF77 Telephone 74-U.Sr-2UCO
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- Classs—
Contractor's Address
Contractors E-mail Address
City State F—
Zip F— TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. f t Z 7 -'u 0
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $