HomeMy WebLinkAboutXR2023-0702 - Permit ApplicationPririt Form —) Worksheet for Combo Building & Solar Permit Application of f�` "
r Comm'I I— Residential City of Newport Beach - Building Division (, �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—Building I— Grading
I —Drainage F_ Elec [ Mech f— Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) C Flood F_ Fire r Liq [ Landslide CN/A Floor Suite No
Description of Work
Use F Const Type
4
# Stories # Units (if Res)[ —
Valuation $ P—
Material/Labor
New/AddSF�RemodelSF�—Garage/New/Add
OWNEWS NAME
Last First
-�--- ----------... �_QS --_-.___-.____------
Owners Address Owner's E-mail Address
/� So r� i't ems_ tiJ•c_�_�C11r_c'L��.
City State Zip 1 Telephone—
e�—
APPLICANT'S NAME
Last t r, First m •.
--s
Applicant's Address Applicant's E-mail Address
— J/
�G? �..1
City
-- .CI_
State gl q Zip �— Telephone _ ff
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip [— Telephoner
ENGINEER'S NAME
Last First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State Telephone�—
CONTRACTOR'S NAME/COMPANY Lic NolassF
Contractor's Address
Contractor's Email Address
City
State F Zip F Telephone[
SETBACKS REAR
SETBACKS FRONT PERMITNO. Oz
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES'