HomeMy WebLinkAboutXC2023-0115 - Permit ApplicationPrint Form
F Comm'I
(-Building
Worksheet for Combo Building & Solar Permit Application
I- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(- Grading I Drainage r- Elec
Address
Of Work
I- Mech j- Plum Cu Yd cutl
Cu Yd Fill
1 marling address) F Flood r- Fire
I- Liq (- Landslide r'N/A Floor
Suite No
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M� Use I ff Const Type HI I � 9
Stories # Units (if Res)F_
Ilcw/Hua �)r� Remodel SF
3 O O Garage/New/Add Valuation $ r I�
Material/Labor I'^J OWNER'S NAME
Last SV_ ^ 1
Owner's Address ��Cl S p (_ First
2 n O I' � O
v� Owner's E-mail Address
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City
State C9 f
0 1 �—
APPLICANT'S NAME Zip Telephone
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Last
Applicant's Address 1 J0 First
rTqe ks�ne n Applicant's E-mail Address
city State
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Zip 1 Telephone C6�� )�•Z2_
ARCHITECT/DESIGNER'S NAME b W � �
Last �
Architect/Designer's Address 33YV1 First
1 P (1Cf Lic. No. �
Scam_ Architect/Designer's E-mail Address p`S LA
City
State �— Zip f, Telephone�—
ENGINEER'S NAME��
st r---�—_
Engineer's Address First I Lic. No.F�
Engineer's E-mail Address
City I I —
State F — Zip �—
Telephone�—
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
\A I��� G Contractor's E-mail Address
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City &�,.A ,. _„Yt'J(�)� State
t iTV� Zip Q E Telephone >�
6 s - 3a
SETBACKS REAR —_ SETBACKS FRONT
SETBACKS LEFT PERMIT No. xc,kj" -01 S
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO PLAN CHECK NO. {�GZpJ1j3.OwJ
PLAN CHECK FEES $