HomeMy WebLinkAboutXR2023-0731 - Permit Application___Print Form__ Worksheet for Combo Building & Solar Permit Application
j- Comm'I F_ Residential City of Newport Beach - Building Division oc d • _�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
['Building (- Grading f-Drainage r Elec F Mech ( Plum Cu YdCut- curd Fill
Project Address (Not mailing address) F_ Flood r Fire r Liq i- Landslide FN/A Floor Suite No
Description of Work
UseF ConstTypeF
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clre�#
Stories- # Units (if Res)-
Valuation $
Material/Laborr
New/Add SF�— Remodel SF-— Garage/New/Add -
OWNER'S NAME Last First ^
Owner's Address Owner's E-mail Address
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City State Zip Telepho
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APPLICANT'S NAME Last First GIJV\
Applicant's Address
Applicant's E-mail Address
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City �ti I r r% State ojy4- Zip q �Q Z� Telephone 6 2�
ARCHITECT/DESIGNER'S NAME Last
� pC.CIj i First v„-� Lic No.F—
Architect/Designer's Address Architect/Designer's E-mail Address
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City State �— Zip �— Telephoner
ENGINEER'S NAME Last y1/� C7 /� : G L� FirstI Ar � i a,yi Lic. No. C- 3 6 3_
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Engineer's Address Engineer's E-mail Address
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City State F_ Zip Zip � Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class -
Contractor's Address Atta t is E-mail Address
City _
Zip - TelephoneF ®
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. b0
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $