HomeMy WebLinkAboutXR2023-1268 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building F_ Grading
j—Drainage r Elec r Mech
r Plum CuvdCut F CuYdFill
Project Address (Not mailing address) r Flood
r Fire F- Liq j- Landslide rN/A Floor Suite No
V
Description of Work
Use F—Const Type
StariesF_ #Units (if Res)
New/Add SFF —
RemodelSFF Garage/New/AddF—
Valuation $
Material/Labor
OWNER'S NAME
Last ' C
First 1-/ rv.L It�j'
Owner's Address
Owner's E-mail Address
ytllleea"u�4'� e `;j111Ui1�-c�tt
City { r_;"(,c���,lZ. 7-
fir_: i}r N State C d-\
ZipTelephoneF,
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I
State F_
Zip F Telephoned
ARCHITECT/DESIGNER'S NAME Last First F
�—
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State F
Zip F TelephoneF_
ENGINEER'S NAME
Last �—
First I— Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City
State
Zip F Telephone
CONTRACTOR'S NAME/COMPANY ( i �l �c ,� t, t j Lic. No. (; j ]'JI Class C Z
Contractor's Address
Contractors E-mail Address
City
State C t\
Zip % � /"� Telephone'!Ot
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $