HomeMy WebLinkAboutXR2023-1487 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 01V!
RComm'I ( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1-
rBuilding j Grading rDrainage FElec �Mech
Plum cuYdCut cuYdFill I
Project Address (Not mailing address) r Flood
r' Fire r Liq (— Landslide (-N/A Floor Suite No
Description of Work
Use Const Type s—
# Stories # Units (if Res)r—
Valuat[on
New/Add SF r — Remodel SF r Garage/New/Add
F
Material/Labor `
OWNER'S NAME Last
First
Owner's Addresses
Owner's E-mail Address
City ��� G�' j State 6A
Zip C�,� Telephoner/7 (5
APPLICANT'S NAME Last — ��S ' G First
Applicant's Address
Applicant's E-mail Address
17-�
tjDZ� J �C'lJ
City 0 all'i State
Zip a�Telephone F �i6 7� ' 3
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. r—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F
Zip TelephoneF—
ENGINEER'S NAME Last
First �— Lic. No.f ---
Engineer's Address
Engineer's E-mail Address
City �— State F_
Zip r----- TelephoneF�--
CONTRACTOR'S NAME/COMPANY
Lic. No. Classs—
Contractor's Address
Contractor's E-mail Address
City F_ State r
Zip F_ Telephones
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $