HomeMy WebLinkAboutXR2023-2082 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I Building r- Grading F-Drainage r Elec F Mech F- Plum curdCut I —
Project Address (Not mailing address) F_ Flood F' Fire r Liq r Landslide
of Work
Cu Yd Fill
F-N/A Floor
Il9o-r 4//71 laGAS-
New/Add SFF — Remodel SF �---
o!I Garage/New/Add
Ij Suite Ne
1
I
Use ConstTypel ✓ i
# StoriesP # Units (if Res)F7
F— Valuation �y <
Material/Labor
OWNER'S NAME Last
Owner's Address / First
Owner's E-mail Address
City State r�F—q— ��/
Zip 91 � Telephone 71/ �� _
y' � a /s'.
/irrLtt_ANTS NAME Last I /
AAp-plliiccan—t's Address
I J/5" o?a�, � 4
City lyev Lj
ARCHITECT/DESIGNER'S NAME
State Feli
Last I �f '//
Architect/Designer's Address
City /J/�c / xTe"C State G�
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
First A)/17
Applicant's E-mail Address
Zip 5XeY Telephone yyf — y
First I iljsl Lic No.--
Architect/Designer's E-mail Address
zip `Jvv6j Telephone /g7 - 7.23- /,41a
First
Engineer's E-mail Address
Lic Nof---
State �— Zip F' TelephoneF�
State
SETBACKS REAR SETBACKS FRONT
Lic.No. F� ClassF—
Contractor's E-mail Address
TelephoneF�
PERMIT NO. XR2° 3, 20%2
PLAN CHECK NO. PC OZ3.1$ZU
SETBACKS LEFT SETBACKS RIGHT
USE ZONE ncvci