HomeMy WebLinkAboutXR2024-0744 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
n- Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Plot mailing address) [_ Flood
F_ Fire r Liq I— Landslide [_N/A Floor Suite No
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Description of Work
Use ConstT
�� Type
# StoriesF # Units (if Res)
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Valuation $
New/Add SF 3t S Remodel SF 5 Garage/New/Add
Material/Labo'r
OWNER'S NAME Last k1_
First
Owner's Address
Owner's E-mail Address
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City ACxi State 'A
Zip C72� Telephone 94`j . ZZ
APPLICANT'S NAME Last F51I l EY
First I T_)AV h
Address
Applicant's E-mail Address
rApplicant's
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City I CA6o,rA- P j State l o
Zip rZOJ 3 Telephone V.-q - 63 lbSo
ARCHITECT/DESIGNER'S NAME Last -34111,9First cult- cZ•790/
l r'� Lic. No. c
Architect/Designer's Address
Architect/Designer's E-mail Address
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State _.'f"_
City U`VA PN5
Zip (?_2 ,} 7 TelephoneF�
ENGINEER'S NAME Last f � n)
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First— Lic No. C'� —IS-3
Engineer's Address
Engineer's E-mail Address
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City State 0.}'
Zip F,761,,J:3 Telephone F7/y, s7, _(,s2,�
CONTRACTOR'S NAME/COMPANY
Lic No. F— ClassF_
Contractor's Address
Contractor's E-mail Address
City State F—
Zip F Telephoned
SETBACKS FRONT
PERMIT NO. '
SETBACKS REAR
y14+
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. e,20 0�y
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $