HomeMy WebLinkAboutXR2024-0524 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application o� °Rrm
r Comm'I 7 Residential City of Newport Beach - Building Division
/ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U�
F_ Building r—Grading F-Drainage rElec rMech
v
F- Plum CuvdCut F CuvdFill
�
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide F_N/A Floor Suite No
Description of Work
Use ConstType F_
j
A
# StoriesF # Units (if Res)
D[U VJ40
Valuation Rk
Material/Laabor
New/Add SF� Remodel SF Gara a/New/Add
9
OWNER'S NAME Last _t
t v
First
Owner's Address
Owner's E-mail Address
�J33 c=T,-A't
ILIle lV1fMl 1 jl1 @ Sloe Jl ob�k
City 064-,) CA"', State F�
Zip Fq Telephone /�
APPLICANT'S NAME Last
First \J 1�L4
40
Applicant's Address
Applicant's E-mail Address
3zoZ
j WfYlAA 9W4r6) Cw•�{+vv�w- •Cs
City ,Ct S State
Zip 4�-ZovkTelephonesq Z-Lf
N-f y
ARCHITECT/DESIGNER'S NAME Last
First F— Lit. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City � State �—
Zip TelephoneF_
ENGINEER'S NAME Last
First �— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City �— State �—
Zip F_ Telephone (2Kt,*-At
CONTRACTOR'S NAME/COMPANY a/ l-et - 4 5 f✓ O4 Lic. No. FY6 3�ZClass�
Contractor's Address
Contractor's E-mail Address
--s • rti� � / A�
City State FGt;r
Zip /�. 7 Qt� Telephone
", G l
SETBACKS REAR SETBACKS FRONT
PERMITNO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $