HomeMy WebLinkAboutXR2023-0829 - Permit Application- Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building f- Grading (°'Drainage [- Elec
Address (Not
F_Meth F plum Cu Yd Cut r- Cu Yd Fill
[-_ Flood F- Fire [- Liq r" Landslide FN/A Floor
- � Suite No
New/Add SF1 Remodel SF ZGarage/New/Add
OWNER'S NAME Last
Owner's Address
City Ul� State
APPLICANT'S NAME Last
First
Use ConstType F
# StoriesF_ # Units (if Res)
IValuation $
Material/Labor
Owner's E-mail Address
WCU( ku e CC;xC r4
ZIP G71 J 7C Telephone Cant vA
First
- - --�,.
Applicant's Address -----
Applicant's E-mail Address
City C State h r Zip Telephone - 1�4-1�a)_Z
ARCHITECT/DESIGNER'S NAME
Last First �—
Lic. No. �— --
- -
Architect Designer's Address Architect/Designees E-mail Address
City State
-- -
-------- ---
- - ZAP r— Telephone
ENGINEER'S NAME Last
Engineer's Address
City State �@
First
Engineer's E-mail Address
-
ZiP 177-7 Telephone[
Lic Nof�
CONTRACTOR'S NAME/COMPANY
�1 T{ Lic No. �82Z�- Class C _Z
� --__.-- �-1 7
Contractor's Address -s�ca
Contractor's E-mail Address
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Fir)lttic,Wt-t__
CityM State Zip Tele hone
_ C�-- 92�z P l�t/,q7 Z
SETBACKS REAR
SETBACKS LEFT
n
SETBACKS FRONT �d
SETBACKS RIGHT /.
PERMIT NO.
PLAN CHECK NO.
•
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $