HomeMy WebLinkAboutXR2023-0115 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oFc` o�Tm
F Comm'I rV—/'Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r�uilding F_ Grading F—Drainage F_ Elec F_ Mech F— Plum curd cuts cu vd Fill
Project Address (Not mailingaddress)F_ Flood F_ Fire F_ Liq F_ Landslide I —N/A Floor Suite No
�E2 ( _�'" -(12� 1 7 F
Description of Work
Use s Const Type s
# Storiess # Units (if Res)F
—
Valuation $
Material/Labor
New/Add SFF Remodel SF 1 1— Garage/New/Add F—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
lity l State �— Zip �— Telephone F—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State I Zip F_ Telephones--
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First F_ Lic. No.
Engineers Address Engineer's E-mail Address
City �® State F__ Zip Telephones
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
Contractors Address Contractor's E-mail Address
City State F-- Zip F Telephoned
W0t 3 4P Q f
SETBACKS REAR SETBACKS FRONT PERMIT NO. )(R?023 - Of I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 212. ZQZ'L
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $