HomeMy WebLinkAboutXR2024-1169 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application -- - (rej
r Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r8uilding (— Grading [—Drainage Elec Mech Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) F Flood r Fire r Liq r Landslide rN/A Floor Suite No
7L/3
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Description of Work
Use F—Const Type F_
# Stories # Units (if Res),
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Valuation $ _
Material/Labor / G
New/Add SFF_�— Remodel SF I Garage/New/Add
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OWNER'S NAME Last
I /, li %
v- v
First 1'
o c,_�
Owner's Address
Owner's E-mail Address
703 S l ay)h
city C /(/J
State n
ZiP� Telephone (�
APPLICANT'S NAME` Last
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First
o S , -oe F
Applicant's Address
Applicant's E-mail Address
r i
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City � //�
State
Zip gT� Z Telephone—
ARCHITECT/DESIGNER'S NAME
Last
First F_ Lic. No. �—
Architect/Designers Address
Architect/Designer's E-mail Address
i
city
State �—
Zip F_ Telephone[
ENGINEER'S NAME Last
�—
First— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip F_ TelephoneF--7—
CONTRACTOR'S NAME/COMPANY
Lic. No. I Class
Contractor's Address
Contractor's E-mail Address
j
City �— �—
State �—
Zip �— Telephone
SETBACKS REAR
SETBACKS FRONT
v PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $