HomeMy WebLinkAboutXR2023-0919 - Permit ApplicationPrint Fo.� _ eet',.,, ...,. n.,v auilding & Solar Permit Application
Comm'I City of Newport Beach - Building Division ° r � Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j-Building r Grading F-Drainage r Elec F Mech r Plum cuvdcuT
Cu Yd Fill F
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use Const Type
�[ — # Stories- # Units (if Res)r
New/Add SF SRgmodel SF e _arage/New/Add �— Valuation $
!r J / �- 'i Material/Labor
OWNER'SNAME Last
First
Owner's Address -
Owner's E-mail Address
City b�✓l/\k` Cj �Ju� ,A GOw
y State �—
ZiP �— elephone 71 Li' _ 3
APPLICANT'S NAME Last �—
First
Applicant's Address Applicant's E-mail Address
City I State F_ Zip F� TelephoneF�
ARCHITECT/DESIGNER'S NAME Last F— First F� Lk No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F— Telephoned --
ENGINEER'S NAME Last
Engineer's Address
City
First
Engineer's E-mail Address
Lic. No.F —
State F_ Zip F' TelephoneF�
CONTRACTOR'S NAME/COMPANY _
1 - ( l V \ t uN I J ✓t C Lic No. Class
Contractors Address Contractor's E-mail Address
I_ _ ( ✓ lZ G� In CD� _ c_-, r--�
city f_ � Kt � !t-�, �� Pc.,c_(, State t✓'/F P �Zip V (� 2 �y 1 raj - Telephone �� / 1 l., 1 / h'jj'- 1Z I3'/
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
T� �DZI 7ll
PLAN CHECK FEES $
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