HomeMy WebLinkAboutXR2023-3239 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
FiComm'l r;/nesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding F Grading F-Drainage j—Elec rMech j— Plum Cu Yd Cutl Cu Yd FiltF_
Project Address (Plot mailing address) F_ Flood F- Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use - G ConstType yr
# Stories # Units (if Res)
Valuation $
Material/Labor lq�_1 �
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New/Add SF I — R� I SF ` Garage/New/Add —
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State Zip F— Telephoned
APPLICANT'S NAME Last First /Ire /
Applicant's Address Applicant's E-mail Address
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City /iL ',Oft lSe/.tdj State I(A Zip �2/�2 Telephone � %•_ 2 pj— �j`j
ARCHITECT/DESIGNER'S NAME o /
Last /c �zt,�%i ��' - j First � /1,,L,i� Lic Nb. � ZL��
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ArchitectIDesigner's E-mail Ac[rlress-----—
Architect/Designer's Address(
City Zip r—� TelephoneF_
ENGINEER'S NAME Last First F_ Lic No.F_
Engineer's Address Engineer's E-mail Address
City State �� Zip �Telephoned--
CONTRACTOR'S NAME/COMPANY Lic. NoT � ClassF
Contractor's Address Contractors E-mail Address
City I State r_ Zip �� Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.�r:?/jJL�j.�L%C�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.�-�,��_�, zi!
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $