HomeMy WebLinkAboutXC2023-0481 - Permit Application__Print Form _Worksheet for Combo Building & Solar Permit Application NO
Comm'I City of Newport Beach - Building Division
(- �" Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Building r- Grading
F-Drainage r- Elec r- Mech
r- Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) i- Flood
r- Fire r Liq r- Landslide FN/A Floor Suite No
Description of Work
Use F—ConstType
# StoriesF_ # Units (if Res)F_
Valuation $
Material/Labor
New/Add SFF_— Remodel SFF Garage/New/Add F__
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State I
Zip F_ Telephoned
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I
State r
Zip F_ Telephonel—
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State F_
Zip F Telephone F_
ENGINEER'S NAME
Last �—
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
tale
Zip �— Telephoned
1
[CNTRACTOR'SNAMEKOMPANY ILLI2 _\
S�` n�C Lic No. -77 1r Class
/
ontractol's
Contractor's E-mail Address
i i �r I f� v( i,
` r�n�_
L/
City I��� Y 0 C) F-i . � � State (� Zip / l i� Telephon 7 � Q�(.
/ O0 3370' Z 5
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. Is -00
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 'PC,r?,,D' S ,
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $