HomeMy WebLinkAboutXR2023-3540 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicatipn d -°Rre
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r Comm'I f Residential City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL a wo A Q I �"'Z-n
rBuilding r Grading
[-"Drainage r Elec i-Mech r Plum cuYdCut s CuYdFill
Project Address (Not mailing address) F_ Flood (- Fire r Lid r Landslide f N/A Floor Suite No
scription of Work
Use F Const Type s
# Storiess #Units (if Res)s
New/AddSFF—
Remodel SFs Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME
Last ( t r li i !�k'� First
Owner's Address
Owner's E-mail Address
City'77
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State I,"� Zip ` %>: t Telephone�—
APPLICANT'S NAME
Last First �I
Applicant's Address
Applicant's E-mail Address
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City /
State ��, ,�i Zip r Telephone -, I
l � G. x d t
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ARCHITECT/DESIGNER'S NAME ✓ . r �-
Las `Ji'�L_ --�`) ; First Lic.No.
Architect/Designer's Address
H
Arc itect/Designer's E-mail Address
City
State [---Zip �— Telephone�—
ENGINEER'S NAME
Last L l .' r--'��� First 770 Lic. No.1�
Engineer's Address
Engineer's E-mail Address
City
State F— Zip F— Telephone[ —
CONTRACTOR'S NAME/COMPANY Lic. No. 9u t
e ( 7`� Gass
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Contractor's Address
Contractor's E-mail Address
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city / % (
t, i
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State ���� Zip Telephone -)r t/ % S �- � �� � Y
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.CI• 9200 .
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES S