HomeMy WebLinkAboutXR2023-1982 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o4rE °RAm
r Comm'l F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI F,,
J
v
rBuild ing r Grading F—Drainage F—Elec rMech r Plum CuYdCut l CuYdFill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq F Landslide f_N/A Floor Suite No
Description of Work
Use F—ConstType F_
Stories # Units (if Res)FT
New/Add SF�— Remodel SF Garage/New/Add �—
Valuation
Material abor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City � State �— Zip r TelephoneF—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City �— State F-- Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last First —
Lic No. F_
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State F_ Zip F— TelephoneF—
ENGINEER'S NAME Last First I— Lic, No.F_
Engineer's Address Engineer's E-mail Address
City I State F_ Zip �s TelephoneF_
NTRACTOR'S NAME/COMPANY m (t, l p c LU� ,MC Lic No. ) � Class �3
W� L
ontractor's Address Contractor's E-mail Address
City A — State �— Zip q�— Telephone-7l��
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PCg
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $