HomeMy WebLinkAboutXC2023-0460 - Permit ApplicationPrint Form ( Worksheet for Combo Building & Solar Permit Application
Comm'I (-- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Building F_ Grading F-Drainage F_ Elec F_ Mech
( Plum Cu Yd Cut Cu Yd Fill
ProjectAddressAddress (Not mailing address) F_ Flood
F Fire j— Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F— ConstTypeF_
�m J
If StoriesF_ # Units (if Res)[ —
Valuation $ Ftot000
Material/Labor
New/Add SF� Remodel SFF Garage/New/Add F—
OWNER'S NAME Last J
First Zo
Owner's Address
Owner's E-mail Address
City t. uv' ?)2. t : r C.. State `
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Zip _.�n r J 1
"j ' ���% Telephone � ,
APPLICANT'S NAME Last R i`
First 1 `, T
Applicant's Address
Applicant's E-mail Address
Cityr i i State -ro
11�`-� �IV� L.��
Zip �7//y Telephone
ARCHITECT/DESIGNER'S NAME Last
Lic. No.
First I F`
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip �— TelephoneF_
ENGINEER'S NAME Last
First F__ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip TelephoneF—
CONTRACTOR'S NAMEXOMPANY v ��� ��� , IJ+ `, Lic. No. Class i ) j
ContractorsAddress
Contractor's E-mail Address
V
City h I' �� (� State (- >
I
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Zip 1 G 2 %c�� Telephone101 L4
SETBACKS REAR SETBACKS FRONT
PERMIT NO.6/o
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. e1,11
USEZONE DEVELOPMENT NO
PLAN CHECK FEESif