HomeMy WebLinkAboutXR2023-0513 - Permit Applicationrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm] r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F- Building (- Grading rDrainag Elec ( Mech F Plum Cu Yd Cut Cu Yd Fill
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Project Address Not mailing address)
Flood Fire ( Liq F Landslide Floor Suite No
Description of Work TO 1-0 l+u'�l y 6 L� — ��" Use ConstType
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I irnw i #Stories #Units (if Res)
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Valuation
New/Add SFF_ Remodel SF� Garage/New/Add Material/Labor J
OWNER'S NAME Last � '/u %. (/V (/ First F (Al
Owner's Address 66 __ owner's E-mail Address
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city v� /� State Zip Telephone a15,,7Y50
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
�TelephoneF—
City I ` State �— ZipF_
ARCHITECT/DESIGNER'S NAME Last FAO R AAm V First F� Lic. No. i�
Architect/Designer's Address l _ Architect/Designees E-mail Address
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City -rn�-- �� State f- - Zip /��/ ,� Telephone7�/UI�UIr / 6
ENGINEER'S NAME Last � y� S First Lic. No.3D 07
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Engineer's Address Engineer's E-mail Address
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City SMtl lA- ft- State (c/ 1 — Zlp �7�J Telephone 557111
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CONTRACTOR'S NAME/COMPANY
Lic. No. �Class
Contractor's Address Contractor's E-mail Address
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State [—J Zip �— TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO. X"4_1h-��,�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.�e,"o VM'20
USE ZONE DEVELOPMENT NO ?zg�9z,3' 000 ( PLAN CHECK FEES $
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