HomeMy WebLinkAboutXC2023-0198 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application
[- Comm'I [-Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G SM,'
[-Building [-Grading [—Drainage [-Elec [-Mech
[-Plum Cu Yd cut Cu Yd Fill�
Project Address (Not mailing address) [- Flood
[- Fire [- Liq [- Landslide r N/A Floor Suite No
300
F
Description of Work
Use F—Const Type F_
# StoriesF_ # Units (if Res)F_
Valuation $
New/Add SFF__ Remodel SF F- Garage/New/Add
F—
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State F
Zip I TelephoneF
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City � State F_
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Arch itect/Designer's Address
Architect/Designers E-mail Address
City I State F_—
Zip F— Telephoned
ENGINEER'S NAME Last
First 7 Lic. No.F_i
Engineer's Address
Engineer's E-mail Address
City State
Zip F__ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. Q (�qDO(lassF
lJ
Contractors Address
Contractor's E-mail Address
City State I
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ''t� �' '- ` -" ' �\' to
SETBACKS LEFT SETBACKS RIGHT
p
PLAN CHECK NO. t3 � '✓CJ
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S