HomeMy WebLinkAboutXR2023-1329 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division h
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding Grading (—Drainage F_ Elec r Mech
F_ Plum cuvdCut F CuvdFill F
Project Address (Not mailing address) F_ Flood
r Fire r Liq F_ Landslide [_N/A Floor Suite No
310 JasMIne A45-
Description of Work
Use F—ConstType
Pell o S 2 S4,eo
# Stories[ # Units (if Res)
GII hcrp/Stq Lands t'n art w'�nr/ hu.S'L
New/Add SFF Remodel SFF—Garage/New/AddF—
Valuation $
Material/Labor
OWNER'SNAME Last Fiot�
First _fz tW
Owner's Address
Owner's E-mail Address
3 to Tos/llir� Ave.
NIA
_
City l CpIZ/iq ,I M�,r State �Ch
Zip I "(TelephoneN�
1FFiirsstt ,7
APPLICANT'S NAME Last
Applicant's Address _
Applicant's E-mail Address
City State
Zip F_ TelephoneF
ARCHITECT/DESIGNER'S NAME Last
First F —Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip F Telephoner
ENGINEER'S NAME Last
First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoner—
CONTRACTOR'S NAME/COMPANY
Lic. No. F100A00class
Contractor's Address
Contractor's E-mail Address
City State
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Z��, 7' k Z C1
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. f6 Z6-"Z
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES 5