HomeMy WebLinkAboutXR2023-0121 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application
r Comm I jx Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r;Grading rDrainage FElec rMech (—Plum CuvdCut F CuvdFill
Project Address (Not mailing
address) r; Flood r Fire rLiq r Landslide r'N/A Floor Suite No
30 Fernleaf
F_ I__._..
Description of Work
Use F—ConstType F
Planter walls within 3 ft. of property line: 20 LF x 3.5 ft high & 22 LF x 2.8 ft high
# Stories', # Units (if Res)F_
._... ____....
Valuation
_
New/AddSF� Remodel SF�� Garage/New/Add
$ /Q P U U
Material/Labor �
OWNER'S NAME Last--_�
First
Owner's Address
Owner's E-mail Address
City
State I '', Zip Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F Zip F Telephoned—',
ARCHITECT/DESIGNER'S NAME
Lic. No.
Last First F_ �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip F— Telephone --
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City �
� State I Zip F_. Telephoned —
CONTRACTOR'S NAME/COMPANY
n jQ� rAn ncJ ,� / Lic No. I' �gZ Class C
LL / V I��
Contractor's Address
Contractorss E-mail Address
City
State F__ Zip I Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. x/�, �Z ✓' D�Z
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
b
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $