HomeMy WebLinkAboutXR2023-3226 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit application
F Comm'[ F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F_Building F_ Grading <Drainage r Elec F_ Mech r Plum CuvdCut F CuYdFill
Project Address (Not mailing
address) I— Flood F_FireFire F_Liq r` Landslide F_N/A Floor Suite No
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Description of Work
Use F—Const Type F_
# StoriesF # Units (if Res)1_
Valuation $
New/AddSFRemodel SF Garage/New/Add—
Material/Labor
OWNER'S NAME Last
j jC`t/ First I % : Vr j
Owner's Address
Owners E-mail Address
J 7'77 / i?r i+,/1l?� /7/_°. 1. �.r,. J-fi �,/�- 1144i L
City f/t <. l Z i� I
State IT Zip `/ Telephone `1 5"7j '7
APPLICANT'S NAME Last
/i_—/ First ! %,.jV/ s
Applicant's Address
Applicant's E-mail Address
City
State Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME
Last First I-C.No.��
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State I— Zip F_ Telephoned
ENGINEER'S NAME Last
First F Lic. No.1�
Engineers Address
Engineer's E-mail Address
City �—
State �� Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY
e %' ,1- ; J . C ' J_ Lic No. 5 ! Class
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Contract is Address
ractor's E-mail Addr
City
State r Zip Telephone
SETBACKS REAR
SETBACKS FRONT O� P��,,E��FjNflT NO. ke2DZ3 - `�2Z
O CHECK NO.
SETBACKS LEFT
SETBACKS RIGHT LAN
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES S