HomeMy WebLinkAboutXR2024-0379 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r-Comm'I (r�Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF OF si iRnnITTAi ,
"Wilding F Grading F--Drainage F_ Elec r Mech r Plum cuYdCut F_ CuYdFill
Project Address (Not mailing address) F_ Flood r- Fire r Liq F_ Landslide FN/A Floor Suite No
11CA6 12n-e 9 /��i f �4 rs
Description of Work %Z�-fr-` iA p
Use ConstType
It # Units (if Res)
Lie,
/
+'� L/�G/t% tR` G✓'��L6 /�"/A'`- �/LFNE�S IN�G�C : �S- ��-�rJ�
Valuation $
Material/Labor rz� alo? "
y sTOxA
New/Add SFI $ern el SF /'J�C% Garage/New/Add �—
OWNER'S NAME Last %�j, First
Owners Address Owner's E-mail
City F— State �— Zip F— Telephone �—
APPLICANT'S NAME Last 7—A 'A x First /a
Applicant's Address Applicant's E-mail Address
rjZ
City State ( Zi p 7 •/ p Tele hone
ARCHITECT/DESIGNER'S NAME Last XAx 11#1/YI First /Dt � Lic. N
/ —
Architect/Designer's Address Architect/Designer's E-mail Address
City ae Zip TelephoneF—
ENGINEER'S NAME Last First F_ Lic, Nof—
Engineer's Address Engineer's E-mail Address
City � State �— Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F— Classr—
Contractor's Address Contractors E-mail Address
City [— State F_ZipF TelephoneF_
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ('_:
"
9
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $