HomeMy WebLinkAboutU2024-0021 - Permit ApplicationForm_ Worksheet for Combo Building & Solar Permit Application o Ew�,rm
F Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading r-Drainage rElec rMech
F- Plum cuydCut cuYdFill
l
Project Address (Not mailing address) F_ Flood
r Fire i— Liq r Landslide f N/A Floor Suite No
Description of Work
Use F—ConstType
(� J sr / / Z
# Stories #Units (if Res)
New/AddSFF__ Remodel SF Garage/New/Add—
Valuation $
Material/Labor
OWNER'S NAME Last I /' �1
/ayr First
Owner's Address
Owner's E-mail Address
%eG' 7 .¢'.� ,-��- A«/
City `_ �4 State CE4
Zip zk,_ / TelephoneT/4/-
APPLICANT'S NAME, Last 7 R/ 5�i . jt-C . ice%( First
Applicant's Address
Applicant's E-mail Address
/ / y / z / z,Zc,
City 5, t 4,, / vti t- State �/4
Zip 7 Z J,, j� Telephone � Y l LJ z.7 - 3 7S 5
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City State F—
Zip [_ Telephoned
ENGINEER'S NAME Last
First F— Lic. No.r
Engineer's Address
Engineer's E-mail Address
City State �—
Zip I Telephone
CONTRACTOR'S NAME/COMPANY-
7 y"1Lic No.�Class
F
Contractor's Address
Contractor's E-mail Address
`/ z!Z 2r?Cy'o
City 17:,f ,t n, State Cs9
Zip 7c F Telephone ;/ 1 / - 4 1- Z -S 7 S- S
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ULO�_w `
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $