HomeMy WebLinkAboutXR2023-1202 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application W�
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFS ni IF AT TIMr nF ei ianniTTAi o
F_Building i— Grading
rDrainage r Elec r Mech f Plum CuYdCut F_ CuYdFill
Project Address (Not mailing address) F_ Flood j_ Fire r Liq r Landslide i—N/A Floor Suite No
Description of Work
Use F—Const Type
# StoriesF_ # Units (if Res)[ —
Valuation $
Material/Labor / '� 6,��c
New/Add SF F
Remodel SF %I Garage/New/Add F—
OWNER'S NAME
Last
�(.�j-j"Q� j First
Owner's Address
Owner's E-mail Address
Cihi
State �— Zip F_ Telephoned
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City I
State �— Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F_
Lic. No. �—
ArchitecVDesigner's Address
ArchitecUDesigner's E-mail Address
City
State �— Zip �— Telephone
ENGINEER'S NAME
Last First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class
Contractor's Address
Contractor's E-mail Address
City
State �— Zip �— /TalephoneF—
SETBACKS REAR
SETBACKS FRONT IT N0, X�/i�z
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
PLAN
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $