HomeMy WebLinkAboutXR2023-2703 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
j— Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r Elec r Mech r plum CuYdCut F cuYdFill
Address (Not mailing
.11
Remodel SF
OWNER'S NAME Last
Owner's Address
city
APPLICANT'S NAME Last
State I
r Flood r Fire r Liq r Landslide
Applicant's Address
City I State �—
ARCH ITECT/DESIGNER'S NAME Last
Garage/New/Add I
Architect/Designer's Address
City I State �—
ENGINEER'S NAME Last
First
Owner's E-mail Address
(—N/A Floor Suite No
/:z. F I (
Use F_ ConstTypeF
# StoriesF # Units (if Res)[ —
Valuation $
Material/Labor
Zip I TelephoneF_
First
Applicant's E-mail Address
Zip (_ Telephone�—
First F_ Lic. No. F—
Architect/Designer's E-mail Address
Zip [— Telephoned
First
Lic. No.F-
Engineer's Address Engineers Address
City �— State r Zip [— Telephoner—
NTRACTOR'5 NAME/COMPANY /Lic. No. Class
� l5
L >�_
Contractor's Address Contractor's E-mail Address—1 U
City State �- Zip Telephone-673
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $