HomeMy WebLinkAboutXR2023-1118 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding r Grading rDrainage r Elec r Mech
j— Plum cuvdCut F_ CuydFill
Project Address (Not mailing
address) f Flood
r Fire r Liq r Landslide i—N/A�Fllloor Suite No
C lic( `' '��-j'l�C:
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Description of Work
r�
Use ConstType I
# Stories # Units (if Res) r j
Valuation$
Material/Labor
New/Add SF - Remodel SF 1 l 2 Garag e/New/AddF_
OWNER'S NAME Last.
r (M
First
Owner's Address
Owner's E-mail Address
City I yj Yn,_7
State F
Zip [— Telephone �—
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State �—
Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME
ul�(�J First Lic. No. 1
Last , u� I (,2.1.7
Architect/Designer's Address
Architect/Designer's E-mail Address
ZI�,
"c
�City
pol�
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- State ut
Zip Telephone ��QC�I'LZj`'(j
ENGINEER'S NAME Last
First F— Lit. No.1
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip I Telephone
CONTRACTOR'S NAME/COMPANY
Lic No. F— ClassF—
Contractors Address
Contractor's E-mail Address
City
State
Zip F_ Telephoned.
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. x, Lv v3
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $