HomeMy WebLinkAboutXR2023-3186 - Permit ApplicationPrint Form Woritsheet for Combo Building & Solar Permit Application `,e^.
City of Newport Beach - Building Division:-
�- Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `'•'
F_Building Grading F-Drainage F Elec r Mech j- Plum cuvdCut CuYdFill
Project Address (Not mailing address) r Flood F- Fire r Liq r Landslide F_N/A Floor Suite No
Description of Work _ Use ConstType F
# StoriesF # Units (if Res)
12 OCR &Mfy mhn 1 Valuation $ �- Fli�000
New/Add SF Remodel SF Garage/New/Add � Material/Labor
OWNER'S NAME Last Iiaf First) �e �C /��J(�s7
Owner's Address Owner's E-mail Address `/ l
City �1 ' y q ®— ��jy�`, State �/' JL- Zip 63' Telephone
APPLICANT'S NAME Last I / I
Applicant's Address
City lq l �, /State
First) ffe ,/t
Applicant's E-mail Address
iM o�lvS�Lt
Zip Telephone
�V J rj(��J/Q7i rj• >C1fZ�
ARCHITECT/DES) NER'S NAME Last L Lp { ; h� Firstue( Lic No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
F— pin,' 1i10.t�'Co'+ti�
City I State �— Zi Telephone �23 ( r, 06 L
l0
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ENGINEER'S NAME Last FirstIr C---
Lic.No.fg
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractors Address
City
SETBACKS REAR
SETBACKSLEFT
USE ZONE
State F
Engineer's E-mail Address
Zip Telephoned'
Lic No. F— Class
Contractor's E-mail Address
State �---Zip F_ Telephone)
SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK O.
DEVELOPMENT NO PLAN CHECK FEES$
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