HomeMy WebLinkAboutXR2023-2019 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit_ Application
Comm'I r Residential City of Newport Beach - Building Division SeM
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
5 building j- Grading rDrainage r Elec r Mech
j— Plum cu vd cut Cu Yd Fill
Project Address (Not mailing address) Flood
r Fire r Liq r Landslide r_N/A Floor Suite No
Description of Work
Use ConstType F
l
t
# Stories # Units (if Res)s
Valuation $
Material/Labor
New/AddSFs Remodel SFF— Garage/New/Add
OWNER'S NAME Last Gy
First /
Owner's Address
Owner's E-mail Address
City l GU..JI+;2 r �� ���]„ -- State 4_
�C
Zip (D Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City �— State F—
Zip F_ Telephones
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City � State F_
Zip Telephoned
ENGINEER'S NAME Last
First [—- Lic. No.s
Engineer's Address
Engineer's E-mail Address
City State F—
Zip r TelephoneF
CONTRACTOR'S NAME/COMPANY
Lic. No. F—Classs
Contractor's Address
Contractor's E-mail Address
City State F__
Zip F Telephone[ —
SETBACKS REAR SETBACKS FRONT
PERMIT NO. " 5- 2oI
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $