HomeMy WebLinkAboutXR2023-1357 - Permit Application— Print Fonni—I Worksheet for Combo Building & Solar Permit Application
I Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(-Building f- Grading F'Drainage [- Elec F_Mech
PIUm Cu Yd CutF Cu Yd Fill
Project Address (Not mailing address) (- Flood
_ [Fire [- Liq r" Landslide [N/A Floor
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OWNER'S NAME
Suite No
Use s ConstType l
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# Stories # Units (if Res)s
Remodel SFL aD r/_ Gara a/New/AddF — Valuationa
-F--- g Material/Labor 15�1
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Owner's Address cZv 8 -
City Nw /
State
APPLICANT'S NAME
Last
Owner's E-mail Address
Zip
Applicant's Address
City Cos /lit crg State �-
- - -- Zip
ARCHITECT/DESIGNER'S NAME
Last
Address
C ity
First
Applicant's E-mail Address
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irst �—
ct/Designer's E-mail Address
ENGINEER'S NAME Las
First F -
Engineer's Address - - --
Engineer's E-mail Address
City -- -
--.
State Zip F Telephones
Lic. No. F--
Lic. No.F___
CONTRACTOR'S NAME/COMPANY
Lic No.
Contractor's Address + pa ✓�(a��n �.«� - g� S 6 Class
Contractor's E-mail Address
City IJ4cT�w/ 11/l�K 6)- p�G.3yCtt3�
(� �/,/r'a c State �� Zip 7136`y Telephone®
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TBACKS REAR SETBACKS FRONT
TBACKSLEFT SETBACKS RIGHT
E ZONE
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO,
PLAN CHECK FEES $