HomeMy WebLinkAboutXR2023-0853 - Permit ApplicationP(int,Fo!f__j Worksheet for Combo Building & Solar Permit Application
r Comm'I (— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j—Building I— Grading rDrainage r Elec r Mech (— Plum Cu Yd Cuts) Cu Yd Fill s
Project Address (Not mailing
11On AIIW`GY`, �I
of Work
r Flood r Fire F_ Liq r Landslide
FN/A Floor j Suite No
I
Use F_ ConstType r—
/1 1' # Stories # Units (if Res)r-
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Valuation $ P
New/Add SF�Remodel SF�Garage/New/Adds--Material/Labor'
OWNER'S NAME
Owner's Address
City
APPLICANT'S NAME
Applicant's Address
Last
First
Owner's E-mail Address
State F_ Zip F_ Telephoner------
Last l COI i ✓` S First
Applicant's E-mail Address
City
State �— Zip [_ Telephone[—
ARCHITECT/DESIGNER'S NAME Last First— Lic. No. r ----
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephoned ----
ENGINEER'S NAME
Last
First I
Lic. No.I
Engineer's Address
Engineer's E-mail Address
City �
State F_
Zip F_ Telephones--
Lic No.
`i 4 9 i { 5
Class C-i�
CONTRACTOR'S NAME/COMPANY oC
Contractors Address
Contractor's E-mail Address
City —
State F_
Zip �— TelepponeF-,—
YN
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK N
USE ZONE
DEVELOPMENT N
PLAN CHECK FEES $