HomeMy WebLinkAboutXR2023-0992 - Permit ApplicationPrint Form
F Comm'I
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
?�euilding F_ Grading
r-Drainage r Elec F_ Mech F— Plum CaYdCut CuYdFill
Project Address (Not mailing address) r Flood
r Fire r Li andslide _N/A Floor Suite No
Description of
1/V
Use F Const Type F
^^Work
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In�t
0
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# StoriesF # Units (if Res)F—
Ij
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Valuation $ !`�---
Material/Labor
New/Add SFF— RemodelSF7
Garage/New/Add l
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
W�W AA 1
D
CityTEM
State
Zip Telephone
APPLICANT'S NAME
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Last yl�'if1J LQnl� FirstI WA ''D
I ►' 1 ur (/J1�/1' V
Applicant's Address
Applicant's E-mail Address
M YV,Q
City
State
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Zip F— Telephone I y�
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ARCHITECT/DESIGNER'S NAME Last First 7 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_
Zip F_ Telephoned
ENGINEER'S NAME
Last I /JI I I1 ^
' V "I
First �� Lic. No. rl/
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Engineer's Address
J
Engineer's E-mail Address
City
State �—
Zip T Telephone t.�'r�S C I �'
t
CONTRACTOR'S NAME/COMPANY / J
v
Lic No.. F) MClass
Contractor's Address
Contractor's E-mail Address
I
City ,
State /s' {�
Zip - ��n[1„ Telephone G 7
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X.`L
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
7
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