HomeMy WebLinkAboutXR2023-2727 - Permit ApplicationNrint Form I Worksheet for Combo Building & Solar Permit Application @'N"3
City of Newport Beach - Building Division
F_ Comm] ResidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuiIding Grading rDrainage r Elec F_ Mech
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(— Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood F_ Fire Liq j— Landslide F_N/A Floor Suite No
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Description of Work
Use � ConstType
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# Stories #Units (if Res)[ —
Valuation $
Material/Labor
New/AddSF7__ RemodelSFF Garage/New/AddF
OWNER'S NAME Last `
First 7 �, ) e ,
Owner's Address
Owner's E-mail Address
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City �j\I State c /\
Zip clZ(eL o Telephone gKtZ-GL-ILA-56Qd\
APPLICANT'S NAME Last t�c��ern,; S}G�Firs! �"
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Applicant's Address
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Applicant's E-mail Address
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City N State
Zip Cl Z�tt Z Telephone �—
ARCH ITECT/DESIGNER'S NAME Last 1 Vn e -
r z z First o S Lic. No. F—
Architect/Designees Address
Architect/Designer's E-mail Address
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City I� �,nnr 1 �\ State C f\
Zip I Q Z 6 1 Telephone Si6 — c ( 15
ENGINEER'S NAME Last I
First F_ Lic. No.[—
Engineer's Address
Engineer's E-mail Address
City State F_
Zip Telephone F_
CONTRACTOR'SNAME/COMPANY �
-1Lic.No. i� Class \2
Contractor's Address
Conjtractor's E-mail Address
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City I JV State F
Zip51 LI (2' Telephone Cj&NU_ qU
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $