HomeMy WebLinkAboutXR2024-0140 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential
City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ,oa.•
F Building r- Grading F Drainage r Elec I-Mech
j- Plum Cu vd Cut Cu Yd Fill l
Project Address (Not mailing address) I- Flood
r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use F—ConstType
# StoriesF_ # Units (if Res)F
Valuation$
MateriaVLabor�
New/Add SF�— Remodel SF� Garage/New/Add Ir
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
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City !�e r rk I��c L� State
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Zip qp ( c) Telephone
APPLICANT'S NAME Last
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First
Applicant's Address
Applicant's E-mail Address
City V State Eov-
Zip G �� Telephone. Gt 1k,�- q,- I
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F_ Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State F—
Zip r_ Telephoned
CONTRACTOR'S NAME/COMPANY
J1 I1.J S Lic. No. I0�3�ZT Class
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Contractor's Address
Contractor's E-mail Address
City �-rv; ,^ State L/-F
Zip Telephone G�..c�- (j- 74-
SETBACKS REAR SETBACKS FRONT
PERMIT NO. a O'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. C Z®Z - 010,5
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $