HomeMy WebLinkAboutXC2023-0339 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
7Comm'I -Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage Elec i- Mech Plum I�
Cu Yd Cut l Cu Yd Fill
Project Address (Not mailing address) F Flood r Fire f- Licl r Landslide FN/A Floor
� Suite No
Description of Work
t Use F ConstType
# Stories # Units (if Res)
New/Add SF f _ Remodel SFF— Garage/New/Add r—
OWNER'S NAME Last i( J �+
First F
--
Owner's Address �v
Owner's E-mail Address
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City �_ �� State [472/^ Tele
Zip 1,�- nY
APPLICANT'S NAME Last - (I
Applicant's Address
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City �ar/� State
valuation $
Material/Labor FS,
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First I J 1 my" Applicant's E-mail Address ` JJ
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Zip RZ Telephone �C
ARCHITECT/DESIGNER'S NAME Last
First F----- Lic No. �---
Architect/Designer's Address Architect/Designer's E-mail Address
City F� State Zip [-- Telephone[ —
ENGINEER'S NAME Last
Engineer's Address
First
Engineer's E-mail Address
Lic. No.F—
City I State F—
ZIP [_ Telephone[ —
CONTRACTOR'S NAME/COMPANY •1'� wrr �; n Lic. No. 'O M Class q 7
Contractor's Address • 1'�t' uY(jr I Contractor's E-mail Address
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City j� , L A State Zip
Z Telepho �� , qrl,�(Aj
SETBACKS REAR SETBACKS FRONT PERMIT NO, SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Vi/i)'L% • Zr f7 i 7
USE ZONE DEVELOPMENT NO PLAN CHECK FEES 5