HomeMy WebLinkAboutXR2023-2779 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 9ew-O",
City of Newport Beach -Building Division
r Comm'I residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_Gradingr-Drainage r-Elec r-Mech
rPlum CuvdCut F CuYdFill
�
Project Address (Not mailing address) r- Flood
r- Fire r- Liq r- Landslide r-N/A Floor Suite No
scription of Work
Use Const Type
zr !a (T\V A,
# Stories #Units (if Res)
Valuatio
Material/Labor T/ �Jr l%dli
New/Add SFF- Remodel SFF-Garage/New/Add Ir
OWNER'S NAME Last I
�iLl i�ilJ-�l
First VLf . /-�
Owner's Address
Owner's E-mail Address
City /J p "
State l/,Z-
Zip IZ (oZGiTelephoneF—
APPLICANT'S NAME Last
W O d 17
First
Applicant's Address
Applicant's E-mail Address
14 a l.t
F5-iz-A H ► . t.1 15�T
City N , 13 -
State
Zip Gf 7 (p(p6 Telephone 'j (� OO zJ - q r7 3?,
ARCHITECT/DESIGNER'S NAME
Last I // j t,% GI t-f 1
First 7— Lic. No. F7Z 3 3 4-
Architect/Designer's Address
Architect/Designer's E-mail Address
Li/ar`/1L ^-�;,
City I
State F_
Zip F Telephoned
ENGINEER'S NAME Last
� � �
First F Lic. No.F---
Engineer's Address
Engineer's E-mail Address
I po r-T d -,�-i
City
State lj,d,
Zip �7r1 4 L4 Telephone -T�"C7 • zf2DD
CONTRACTOR'S NAME/COMPANY
Lic. No, F-- Classr—
Contractor's Address
Contractor's E-mail Address
City
State F_
Zip F Telephone7
SETBACKS REAR
SETBACKS FRONT
./� I l(j�
PERMIT NO. 2 _U23' L-1-I
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $