HomeMy WebLinkAboutXR2023-1215 - Permit ApplicationPrint Form
j Comm'I
I Worksheet for Combo Building & Solar Permit Application
j } Residential City of Newport Beach - Building Division
ii�t NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
V�Building r Grading rDrainage F_ Elec r Mech
F Plum CuYdCut CuYdFill
Project Address (Not mailing address) F Flood
r Fire r Liq r Landslide AN/A Suite No
Floor
Description of Work (:;.fit /,� �G'GL,)
r ' r "
Use ConstT 7
YPe
�"(./G1
#Stories It Units (if Res)
/pj 7 r,4I� 1 Ail%" ( G��J l i-i1 f;I ) Li 1; ��./I M
Valuation $
New/AddSFF Remodel SF /'/ ) Garage/New/AddF—
Material/LaborF1711
�OWNER'S NAME Last ,-1'is
First
Owner's Address
Owner's E-mail Address
Clty State
Zip Telephoned
APPLICANT'S NAME Last '
titc'%Z�
First
- >cJly
Applicant's Address
Applicant's E- Address
i,/'�`{ State C
City f�'.S0
''
Zip Cft, Telephone
%First
Lic. No.
ARCHITECT/DESIGNER'S NAME Last JJ
ArchitecUDesigner's Address t�.
Architect/Designer's E-mail Address
City State F
Zip F— TelephoneF_
ENGINEER'S NAME Last//')/' % j r
First {� It Lic No.F—
Engineers Address
Engineer's E-mail Address
Cit 7 State
y G"�)"t`
Zi Tele hone ( �•r-
p p .Z_ - ,?T_ J
%iGCEi�Ic
CONTRACTOR'S NAME/COMPANY j' %� Lic. No. F— ClassF_
Contractor's Address
Contractors E-mail Address
City �— State F__
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. r•Y 2023— to �1'
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ X,VL aoz3 ^ AZ]S