HomeMy WebLinkAboutXR2023-3210 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F_ Comm] F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building F_ Grading
F-Drainage F_ Elec r Mech
j Plum cuYdCut s CuYdFill F
Project Address (Not
mailing address) F_ Flood
j- Fire r- Liq j- Landslide f N/A Floor Suite No
Description of Work
Use s ConstType s
It Storiess # Units (if Res)s
Valuation $
Material/Labor
New/Add SFs Remodel SFs Garage/New/Add F—
OWNER'S NAME
Last G ` rCi7l JGe
First
Owner's Address
Owner's E-mail Address
7
City �- 6-J G' State U i '
Zipr -(� Telephone ��r� -'
APPLICANT'S NAME
Last
First /J )IeL. GIIC'lIFG J
Applicant's Address
Applicant's E-mail Address
C. j re? Fj,'r).i lf- C - = n
city �� j:� �J j�-
State
Zip. 7 Telephone[
ARCIIIT T/DE5IGNER'5
ME Last First — Lic. No.F
Architect/Design ss
Architect/Designer's E-mail Address
City I
State �
Zip Telephones
ENGINEER'S NAME
Last 1
i
First Lic. No.F—
Engineers Address
Engineer's E-mail Address
City I
State f —
Zip �--_'--" Telephoner —
CONTRACTOR'S NAME/COMPANY
F L C
Lic No. IwClass
Contractor's Address
Contractor's E-mail Address
a>/S G arc' /7t
' 1�l'J .
/11S��NSc'✓ ��/ ,l'li}ice . C 0 YI
City i�J/%� �� l�fi (C) State (' �
Zip �,3L -,;Z Telephone .7/1Y
SETBACKS REAR
SETBACKS FRONT�0e) tb PERMITNO.X �J�/�.•
SETBACKS LEFT
SETBACKS RIGHT
1'
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES S �.,