HomeMy WebLinkAboutXR2023-2124 - Permit Application-Print Form Worksheet for Combo Building & Solar Permit Application °SEW°°qre
City of Newport Beach - Building Division
(�; Comm'I ( Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Gam'
r-Building F, Grading
FDrainage F7Elec F_Mech F- Plum curdCut 177 CuvdFill F7
Project Address (Not mailing address) CFlood F_ Fire r Liq r Landslide FN/A Floor Suite No
1
Description of Work
Use ConstType s
# Stories # Units (if Res)s
Valuation $
Material/Labor
New/Add SF
Remodel SFF— Garage/New/Add �
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City State �— Zip F__ Telephoned
APPLICANTS NAME
Last First
Applicant's Address
Applicant's E-mail Address
City _
State Zip F— Telephone
ARCHITECT/DESIGNER'S NAME Last First �— Lic. �—
No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State �— Zip F TelephoneF
ENGINEER'S NAME
Last First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City — _
— State Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY \ tikF1' Lic. No. `c i t, t, Class
Contractor's Address
Contractor's E-mail Address
L L
City 1
State Zip L Iy —Telephone
-- —
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 1
�v
SETBACKS LEFT
T�
SETBACKS RIGHT PLAN CHECK NO. I
USE ZONE
DEVELOPMENT NO PI AN r:HFrtK FFFS Q