HomeMy WebLinkAboutXC2023-0396 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application °4"`�
City of Newport Beach - Building Division
�' Comm'I F_ Residential � �.
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G„
1 9uilding r Grading F-Drainage r Elec j-Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood j- Fire F_ Liq r Landslide r_N/A Floor Suite No
Description of Work
Use F—Const Type
C4 it
# Stories[— # Units (if Res)F_
Valuation 21 6
Material/Labor
bor
New/Add SF �-� , S- Remodel SF Garage/New/Add
I
OWNER'S NAME Last
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First
Owner's Address
Owner's E-mail Address
City /;vZ_Q oc,'\ r�tT,
Stater F}
ZiP 02(,o -/5- Telephone 'I'll . i (� .'y 0
APPLICANT'S NAME Last
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First �y l
Applicant's Address
Applicant's E-mail Address
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City �
State cA
Zip Telephone U
ARCHITECT/DESIGNER'S NAME
Last First I
Lic. No.
Archrect/Designer's Address
Architect/Designer's E-mail Address
City I
State �—
—
Zip r — TelephoneF
ENGINEER'S NAME Last
�—
First Lic. NoF_
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY
Lic. No. Ip1�(sr-{G ClassF-'��
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Contractor's Address
Contractor's E-mail Address
City 5 I
State �'�-
Zip SG 5 Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.f�-,.'�1�/-` �t�•-'�_Li`'�
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $