HomeMy WebLinkAboutXR2023-1034 - Permit ApplicationPrint ForF71 Worksheet for Combo Building & Solar Permit Application as
F Comm'I r Residential City of Newport Beach - Building Division
/NOTE: PLAN CHECKFEES DUE AT TIME OF SUBMITTAL
Building r Grading
Iv
r-Drainage r-Elec Mech Plum Cu yd Cutl� Cu Yd Fill I�
Project Address (Not mailing address) r Flood r Fire t- Liq r Landslide rN/A Floor Suite No
Description of Work
Use ���onstType
IF Stories # Units (if Res)
New/Add SFF�---
Remodel SFI 711;/ Garage/New/Add
Valuation $ F
Material/La r
OWNER'S NAME
Last I WA Lt, First
Owner's Address
, .•'`z/
Owner's E-mail Address !Li
S r�IJ� Pj Aj G-7 iJ r= fFgr( __r
�
City r/ -FWf
- , -State GQr ZiP F_ TelephoneF_
APPLICANT'S NAME
Last W P-4Y First
Applicant's Address
Applicant's E-mail Address
City _ NSW J J iaE} State Zip J 65�� TelephoneFl?�7.
ARCHITECT/DESIGNER'S NAME
Last ��1.(G.i`fZ_ First Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Ad/dress /
City 7 tF7
State � fsc Zip G� Telephone �L� ,ZL�.LL0 7_
ENGINEER'S NAME
Last -�, First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State �— ZipF Telephoned
—
CONTRACTOR'S NAME/COMPANY Lic. No. F ClassF
Contractor's Address
Contractor's E-mail Address
City �—
State �— Zip F— Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ✓�� Z'�i Ojjicy
'—t
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $