HomeMy WebLinkAboutXR2024-0591 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
�mm'I residential City of Newport Beach - Building Division o_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r4uilding r— Grading rDrainage r Elec rMech
r— Plum Cu vd Cut Cu Yd Fill F
Project Address (Not mailing address) i— Flood
r Fire r— Liq r Landslide (—N/A Floor Suite No
TvP Fye;
Description of Work
Us Const Type
#Stories #Units (if Res)
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Valuation a
Material/Labor
Fr d0-S
New/Add SF _.Ee+nadeiSF �f/b, � Garage/New/Add �—
OWNER'S NAME `JJ� C p L
Owner's Address
Owner's E-mail Address
City /�Nj�' State I F
Zip � /'7 Telephone ;7��,4,//—
APPLICANT'S NAME Last T
First J,'/
Applicant's Address
Applicant's E-mail Address
net l /� / /2?/3 ��� A ULr
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c A �G -� leU�l00 L Cool
City %IaG /%P (S L_/t 44d State F
Zip F ZG/p L Telephone j-- — � S—
ARCHITECT/DESIGNER'S NAME Last /% X, ) � A-1 y
}1 J First A .0 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City IZip
Telephone
ENGINEER'S NAME Last
First F Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State F
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY (Y ,� jA�
�0� Lic. No. gc5C ��`ylassF
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F_ TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $