HomeMy WebLinkAboutXC2023-0381 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application NP,
F_Coni j— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading
FDrainage rElec rMech
F— Plum cuYdCut F cuYdHIF
Project Address (Not mailing address) F_ Flood
F- Fire r Liq r Landslide r_N/A Floor Suite No
Description of Work
Use F_ ConstType
# Stories # Units (if Res)
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Valuation
New/AddSFF—
Remodel SFF—Garage/New/AddF—
$
Material/Labor ..'
OWNER'S NAME
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Last r ,-� _:<:�'<, � ��v;'S.-� First
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Owner's Address
Owner's E-mail Address
City V r`v
State (;fi
Zip GI 74-/7 Telephone ;4.' 7Z n 3/6-7
APPLICANT'S NAME
Last _
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First t✓ .-ae
Applicant's Address
Applicant's E-mail Address
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City •, 61 Sri
State
J
Zip Telephone�� yQj Cj'
ARCHITECT/DESIGNER'S NAME Last
First F
Lic No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City I
State F—
Zip F— Telephoned
ENGINEER'S NAME
Last
First— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/CO . LjNY S
"• Lic No. u Class G
Contractor's Address
Contractors E-mail Address
City
State F_
Zip F_ TelephoneF_
SETBACKS REAR
SETBACKS FRONT
op
PERMIT NO. W� - Q
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 0 •
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $