HomeMy WebLinkAboutXR2023-1428 - Permit ApplicationPrint Form ___I Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_Grading rDrainage [Elec F_Mech F-Plum CuYdCut F CuYdFill v
Project Address (Not mailing address) [ Flood r Fire f- Liq r Landslide FN/A Floor Suite No
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Description of Work
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#Stories #Units (if Res)
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Valuation $ tr�
Material/Labor
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New/Add SF Remodel SFF--Garage/New/Add 7
OWNER'S NAM Last PFirst
Owner's Address - --
Owner's E-mail Address
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City /V State � Zip Telephone
APPLICANT'S NAME Last wV VL First d k
Applicant's Ad/dress Applicant's E-mail Address
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City 1 State � Zip Z( Telephoner
ARCHITECT/DESIGNER'S NAME Last First F — Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �- Zip F- Telephone
ENGINEER'S NAME Last I/j/le S S t First wvFLic. No. `7 Y
Engineer's Address Engineer's E-mail Address
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City �` d N, 4 t L tS - State I w Zip I C Z Telephone ?[C( ,PE-6 �'C)S UZ
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CONTRACTOOR'SNAME/COMPANY `I f (� Lic No. ??QoR Class �
Contractor's Address Contractor's E-mail Address
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City M& I t State Zip S Telephone q�
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SETBACKS REAR SETBACKS FRONT PERMIT NO. z-Z, -1%2S,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. \5�55$ -00z2
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $