HomeMy WebLinkAboutXC2023-0154 - Permit Applicationworm Worksheet for Combo Building & Solar Permit Application Rr
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Residential City of Newport Beach -Building Division �_>
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
IUOunamg I Grading I Drainage r Elec r Mech r Plum Cu Yd Cut F_
Cu Yd Fill
Project Address (Not mailingaddress) f Flood F Fire f- Liq r Landslide rN/A Floor Suite No
Description of Work
Use F— Const Type
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# StoriesF # Units (if Res)F_
Valuation $
Material/Labor }
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New/Add SFF Remodel SFF—S
Garage/New/Add �—
OWNER'S NAME Last /)
c ����' � First
Owner's Address
Owner's E-mail Address
City r y- its. State I / Zip f ' Telephone— i
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APPLICANT'S NAME Last �' First ,
Applicant's Address
3 Applicant's E-mail Address
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City $SJ�t �11� State ( r'6W
Zip Tele hone 0 n
ARCHITECT/DESIGNER'S NAME LastFirst
�l ` Lic. No. I LJ-- cL>
Architect/Designer's Address Architect/Designer's E-mail Address
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City 7 rvr ,e State— Zip �— Telephone[—
ENGINEER'S NAME Last First —Lic. Nof�
Engineer's Address Engineer's E-mail Address
City F— State F— Zip F_ Telephone[_
CONTRACTOR'S NAME/COMPANY �i T_
C V C/c6^ Lic. No. F Class
Contractor's Address
Contractors E-mail Address
ry 7 ✓
city State Zip L� Y Telephone �(7_ P60r-
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SETBACKS REAR SETBACKS FRONT X C
PERMIT NO. "
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $