HomeMy WebLinkAboutXR2023-3479 - Permit ApplicationpRrm
Print Form Worksheet for Combo Building & Solar Permit Application o?EWP
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading F-Drainage i- Elec ( Mech
( Plum CuYdCut CuYdFill
Project Address (Not mailing address) F_ Flood
F_ Fire r Liq r Landslide ( N/A Floor Suite No
1C; "(u.v P.
F_
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Description of Work
Use r ConstType r
# Storiesr # Units (if Resf —
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V
1
Valuation LI
Material/Labor
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New/Add SF � Remodel SF i v Garage/New/Add �-�
OWNER'S NAME Last �� /� Lr i;
First j r P C e
Owner's Address
Owner's E-mail Address
City /.,i s� State F
Zip Telephoned
APPLICANT'S NAME Last (_,, -; C t-`
First C,t< t.\
Applicant's Address
Applicant's E-mail Address
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City �,��., Ii �` State I"-
Zip F— Telephone F"T 7-11, Z •` r 1 -3
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ARCHITECT/DESIGNER'S NAME Last
First F_
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I— State �—
Zip I Telephoner
ENGINEER'S NAME Last (?..v
First L _,_� Lic. No.F_C
Y
L
Engineer's Address
Engineer's E-mail Address
.ne Y
City C State
-- I t
Zip Telephone q i'✓L
phone
CONTRACTOR'S NAME/COMPANY
Lic No. •_, 1 Class
J
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F--- Telephoner—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $