HomeMy WebLinkAboutS2024-0107 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential
City of Newport Beach -Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
5eBuilding rGrading rDrainage F_Elec FMech rPlum Cu vd Cut Cu Yd FlllF_
Project Address (Not mailing
address) F_ Flood I— Fire r Liq r Landslide f_N/A Floor Suite No
l82 7 Poll' Gti"//es
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Description of Work
Use ConstType
f
Pool Q,40(,S(Jq %Ze.5'(,(f-qtg
RBO�q�C �.'9�t7�S lt/A�PsIAG
# Stories #Units (if Res) s
7p/% . NO SJ'i,.Clug / l/aaAy¢ v� Egcr/(o�tonf 2e�/a<e�/s/ove .
Valuation $
Material/Labor F)51COL
New/Add SF Remodel SF J j Garag a/New/Add
2
OWNER'S NAME Last
DeSlva First STetielf
Owner's Address
Owner's E-mail Address
4?_7 Chal/eS
Ste&e,7ar,&" @�
City lVel gI(&l'f 6G/RC�
State C/" Zip r,-a Telephone (7/4%3ia- 6899
APPLICANT'S NAME Last
�o�'¢e� First /qrb.,/
Applicant's Address
_ Applicant's E-mail Address
Gov W. P,-sec%.'/ Arc ti%k� �� Garc��ei�tc�t �/� ca,✓�
City Dlanq`O
State �� Zip �a$�S Telephone l—.4)z-39y
ARCHITECT/DESIGNER'S NAME
Last N/A First 7 Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State � Zip F_ Telephoned
ENGINEER'S NAME Last
N114 First F_ Lic. No.s
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F__ Telephoned
CONTRACTOR'S NAME/COMPANY
6V Lic. No. Class FC-5
!"
Contractor's Address
Contractor's E-mail Address
6� W-
A l/G /t r iCG� F �J Gq/C G�1RCMo�G� cord
City O�a,,,,C
State C� Zip glg(s Telephone /9li,�/
SETBACKS REAR''
SETBACKS FRONT PERMIT NOLL
SETBACKS LEFT
SETBACKS RIGHT -" PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $