HomeMy WebLinkAboutXR2023-1507 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application o��m
F-Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building r Grading rDrainage r Elec r Mech r Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
IILi v+a
F_
Description of Work
Use F—Const Type
t�cwT I°Ic't11n �c.�i��r
I�s+•,I� II.9�J�J�
#StoriesF # Units (if Res)F_
Valuation $
New/Add SF� Remodel SF�Garage/New/Add F_
Material/Labor7co
F5;
OWNER'S NAME Last
First nm f
Owner's Address
Owner's E-mail Address
City
State Zip F Telephoned
APPLICANT'S NAME Last
Y)o> O First V L7 j N
Applicant's Address
Applicant's E-mail Address
City I
State F___ Zip F Telephoned
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_ Zip F_ Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip I Telephoned
CONTRACTOR'S NAME/COMPANY
ILic No.F 4 s{ ( (S Class C- ( G
.1 J
Contractors Address
Contractor's E-mail Address
City
State F__— Zip F— TeJephoneF
SETBACKS REAR
SETBACKS FRONT l'1 ; P�F IT NO.
V
SETBACKS LEFT
SETBACKS RIGHT 19LAN CHECK NO. AO !z5
USE ZONE
DEVELOPMENT NO "% PLAN CHECK FEES $