HomeMy WebLinkAboutXR2023-0880 - Permit ApplicationI_ Pnht Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF RI IRnnlrrnl
F-Building F_Grading F-Drainage [-Elec F_Mech F-Plum CuYdCutF CuYdFill
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Project Address (Not mailing address) F_ Flood r Fire F_ Liq F_ Landslide N/A Floor Suite No
Description of Work Use F—Const Type F7
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# StoriesF # Units (if Res)F
Valuation $ ��
New/Add SF�— Remodel SF �2�� � Garage/New/Add �— Material/Labor r�('.i;r,7 %J C7
OWNER'S NAME Last a�IC,
First
Owner's Address Owner's E-mail Address
City IN tGLA) rofzi ---- ._� State �— -
Zip TelephoneF-—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
— .-- -
City State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First
-Y- - Lic. No. C
ArchitecNDesigner's Address Architect/Designer's E-mail Address
City __ __.—_---..-.__ State Zip'l5 Telephone
ENGINEER'S NAME Last First F777® Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip TelephoneF 7—
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class
Contractor's Address Contractor's E-mail Address
City State F Zip � Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. X IZZ{1Z�3 — OO
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
Print Form_ Worksheet for Combo Building & Solar Permit Application
(- Comm'I (- (Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c'
F-Building F_Grading r-Drainage F-Elec J_Mech F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood F- Fire F- Lig I- Landslide CN/A Floor Suite No
7
Description of Work Use F—Const Type
Am RA 1'ii 01V AL 0K� woR(s
#Stories #Units (if Res)
I
Valuation $
New/AddSF�— Remodel SF Garage/New/Add— Material/Labor��bU�
OWNER'S NAME Last j-
- � �� First
Owner's Address Owner's E-mail Address
City State Zip [7-- TelephoneF—
APPLICANT'S NAME Last _' ' - - First j p�/I l
Applicant's Address Applicant's E-mail Address
City State �— Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME Last First {
_ _ Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
---.. -- -
City State �— Zip �— Telephoner-7
ENGINEER'S NAME Last First Lic No.�-
Engineer's Address Engineer's E-mail Address
City State F Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. �- ClassF_
Contractor's Address Contractor's E-mail Address
City State �— Zip �- TelephoneF
SETBACKSREAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
7