HomeMy WebLinkAboutXR2023-2272 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building F_ Grading rDrainage r Elec r Mech
F_ Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) f Flood
r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
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#Stories #Units (it Res)[
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Valuation $
�., New/Add SF TRemodel SF Gara
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�'�' Material/Labor 0(:> 6
OWNER'S NAME Last 'L 4�/\
First
Owner's Address
Owner's E-mail Address
12-06
City State F
Zip Telephone
APPLICANT'S NAME Last ��
First F4 �
Applicant's Address
Applicant's E-mail Address
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City �jq�VON State �—
Zip bC. 5-� Telephone'�62-g65-4Z'lr
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ARCH IT DES GNER'S NAME)Last First —
Lic No.
ArchitecVDesigner's Address
ArchitectlDesigner's E-mail Address
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City State I
Zip F_ Telephoned
ENGINEER'S NAME Last Vfb u+o fl
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First i a(� n� Lic No.
Engineer's Address
Engineer's E-mail Address
City State F—
Zip Fa Telephone �./��.?8�(
CONTRACTOR'S NAME/COMPANY
Lic. No. ClassF
Contractor's Address
Contractor's E-mail Address
City 141 State F
Zip 7— TelephoneF
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC2o2s — I9q
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S