HomeMy WebLinkAboutXR2023-0659 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r Elec r Mech
r Plum CuYdCut CuYdFill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide f N/A Floor Suite No
ZOE7�
I I
Description of Work
Use F—ConstType F_
# StoriesF_ # Units (if Res)F_
New/Add SFF_ Remodel SFF—Garage/New/Add F—
Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State
Zip F_ TelephoneF_
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F_
Zip [— Telephoned
ARCHITECT/DESIGNER'S NAME
Last
First Lic. No.
ArchitecVDesigner's Address
ArchitecUDesigner's E-mail Address
City
State F_
Zip I TelephoneF
ENGINEER'S NAME Last
First F__ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F__
Zip Telephoner
CONTRACTOR'S NAME/COMPANY
(� (�����
lJl.,
�11�r Lic No. �, �'l�Class L�; t"
Contractor's Address
Contractors E-mail Address
City-t!.2
Jam=
State FTT7
Zip / I=b Telephone 52L ( F
SETBACKS REAR
SETBACKS FRONT
\ f y
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $