HomeMy WebLinkAboutXR2023-2547 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �`W� @
F- Comm'I F- Residential City of Newport Beach - Building Division t _�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL1.
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uilding F_ Grading F-Drainage rElec rMech
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Project Address (Not mailing address) F Flood
F Fire F- Liq F- Landslide F-N/A Floor Suite No
cription of Work
Use F— Const Type F—
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# StoriesF # Units (if Res) 'F
New/Add SF F_Remodel
SFF Garage/New/Add
F—
Valuation
Material/Labor
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OWNER'S NAME Last
N V LA
First
Owner's Address
Owner's E-mail Address
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City
State �—
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Zip TelephoneF�
APPLICANT'S NAME Last
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First ��em
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Applicant's Address
Applicant's E-mail Address
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State �—
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ARCHITECT/DESIGNER'S NAME
Last
First F_
Lic. No. F�
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
ZIPF_Telephoner�
ENGINEER'S NAME Last
First I Lic. Nof�
Engineer's Address
Engineer's E-mail Address
City
State F—
Zip F— TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City I
State F—
Zip F— TelephoneF_
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
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IUSEZONE
DEVELOPMENT NO
PLAN CHECK FEES $