HomeMy WebLinkAboutXR2023-2719 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
f Comm'I j' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading j—Drainage r' Elec
Project Address I
iy Skt,ASu_,\ D
Description of
Tlk
r Mech j- Plum Cu Yd cut— cu Yd Fill
r Flood F Fire r Liq r Landslide
I —N/A Floor
Suite No
Use F—Const Type F—
# StoriesF_ # Units (if Res)[—
New/Add SF�— RemodelSFF— � IMatuerial/Labor
balation5Garage/New/Add
OWNER'S NAME
Last
Owner's Address J
iq
city
APPLICANT'S NAME Last
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer'sAddress_ kJ
C ity
State _('-
First I B r_ ` } 1
Owner's E-mailAddress
First
Applicant's E-mail Address
State F— Zip [— Telephoner�
First I Lic. No. I —
Architect/Designer's E-mail Address
State F— Zip F— Telephone[�
ENGINEER'S NAME Last
First F� Lic No.F�
Engineer's Address
Engineer's E-mail Address
City State F ZipF_ Telephone[�
CONTRACTOR'S NAME/COMPANY F_ET
Contractor's Address
City �� v r State qqq
SETBACKSREAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
c ff�
zip %D(; PO Telephone ,5' L 3 - `/ 777
PERMIT NO. /\ r lZ-0 Z j —ZZ f! q
PLAN CHECK NO. PCZOz.3. Z 3,,7q
PLAN CHECK FEES $