HomeMy WebLinkAboutXC2023-0313 - Permit ApplicationPrint Form
Comm'I F
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building rGrading rDrainage XEIec rMech rPlum CuvdCut F cuYdFill � `r
Project Address (Not mailing address) I— Flood (— Fire r Liq r Landslide I —N/A Floor Suite No
Description of Work
Use � Const Type I
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IF Stories # Units (if Res)F_
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Valuationa
Material/Labor ) j
New/Add SF� Remodel SF �.� Garage/NewJAdd �—
OWNER'S NAME Last
First I Toery
Owner's Address i
jj i�-,� eI Owner's E-mail Address
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City p
State Zip X) C �`� Telephone
APPLICANT'S NAME Last
Applicant's Address
et.,F ��f(� First i N
./ Applicant's E-mail Addre
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City
State/1 Zip Telephoned
ARCHITECT/DESIGNER'S NAME
Last First —Lic. No.C3/-) 23
Architect/Designer's Address
Architect/Designer's E-mail Address
MS -A
City 0 4. <,/'l
State r Zip FJ/61�( Telephone 3%b .2'0 — �� /
/First
ENGINEER'S NAME Last
/ /j po� �� } fj LJ Lic No.
Engineer's Address
���'f Engineer's E-mail Address
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City `> J y
State Zip I%� is j' Telephone 3) c, 7L t j 7
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CONTRACTOR'S NAME/COMPANY F Lic. No, I ClassF
Contractors Address
Contractor's E-mail Address
City
State �— Zip � Telephoned
SETBACKS REAR
/
SETBACKS FRONT PERMIT NO. (/� Y�OQ�j�t)
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 16"200��� �
USE ZONE
'�K-12
DEVELOPMENT NO PLAN CHECK FEES $