HomeMy WebLinkAboutXR2024-5466 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ozEw�Rm
mm'I i-�sidential City of Newport Beach - Building Division 4
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood r Fire F_ Liq [_ Landslide rN/A Floor Suite No
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Description of Work lU%TGrC� '� �� , %t g� Ui'+T / - 1V
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# Stories o Units (if Res)F
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Valuation $ �O
Material/Labor
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OWNER'S NAME �C_ JCC- �%L!��Cl✓��� v ' % _First / , �v�TtjfZ4�/G'� C 'C`ri.rl`a'G.�',%�f`7
Owner's Address Owner's E-mail Address
City �, �f/ State Zip 1Gd �'7 Telephone `/�q �?�Fi .- 1_7
APPLICANT'S NAME Last ��U d First � if
Applicant's Address Applicant's E-mail Address
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City /J /JG3rr1 �G �„_.] State Zip ` "Zt.r 2 Telephone ��/ `/ARCHITECT/DESIGNER'S
NAME �
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Architect/Designer's Address Architect/Designer's E-mail Address
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City I State Telephone
ENGINEER'S NAME Last �— First F_ Lic. No.�
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephone F_
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractors Address Contractor's E-mail Address
City �— State Zip F Telephone F_
SETBACKS REAR SETBACKS FRONT PERMIT NO. 66
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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