HomeMy WebLinkAboutXR2024-5300 - Permit Application1__ PrintForm I Worksheet for Combo Building & Solar Permit Application q
F_Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL_
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Project Address (Not mailing address) F_ Flood
j- Fire r- Liq r Landslide FN/A Floor Suite No
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Description of Work
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#Stories # Units (if Res)F_
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Valuation $ ,ZC / �(JC
Material/Labor
New/Add SF� Remodel SF Y G Gara a/New/Add I
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OWNER'S NAME Last I fSt'i
First 7�/7
Owner's Address
Owner's E-mail Address
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City /"i'bc.Gc.CIt State 77t-
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APPLICANT'S NAME Last �,e, f /i,(�gJ�(lr'l/
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �J� fk First
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Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State �—
Zip F TelephoneF_
ENGINEER'S NAME Last h A
First �— Lic. No.s
Engineer's Address
Engineer's E-mail Address
City State �—
Zip r— Telephones!
CONTRACTOR'S NAME/COMPANY N Lic. o. Class
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Contractor's Address
Contractor's E-mail Address
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City State �-�i
Zip `�Z7C; �` Telephone ;y,7_C`/G' CCW-
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Yf=%Y—�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO,
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $