HomeMy WebLinkAboutXR2023-3407 - Permit ApplicationPrint Form I Worksheet for Combo building & Solar Permit Application 4_01
r Comm'I ( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F'Building F_Grading
rDrainage j-Elec F_Mech
rPlum Cu vd Cut Cu Yd Fills
Project Address (Not retailing address) F_ Flood r Fire r Liq l-' Landslide F_N/A Floor Suite No
Description of Work
Use I— ConstType s
# Stories[ # Units (if Res)
Valuation$ F71 o o 0
Material/Labor
New/Add SF Remodel SF -- Garage/New/Add I--
OWNER'S NAME
Last Hj FirstI ROW�
W
Owner's Address
Owner's E-mail Address
City
State F
Zip F__ Telephone
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City �
State F_
Zip I r- Telephoned
ARCHITECT/DESIGNER'S NAME Last
First F_ Fi
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
� State �_
Zip r--— Telephone[ —
ENGINEER'S NAME
Last
First qm Lic. No. r—
Engineer's Address
Engineer's E-mail Address
City
State F
—
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address
Contractors E-mail Address
City �—
State r
Zip Telephone—�
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 'PL2G`Zj = LG( U2j
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $