HomeMy WebLinkAboutXC2024-0140 - Permit ApplicationPrint Form-
Comm'I r
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�Ewoogr
Building F_ Grading rDrainage r Elec r Mech
r Plum CuvdCut s CuvdFill s
Project Address (Not mailing address) F_ Flood
r Fire r Liq r Landslide FN/A Floor Suite No
J� AN e/J�I-I_ m I_st -
Description of Work
Use s Const Type I���
a s wl
I
J
# Stories # Units (if Res)F_
_
Valuation $
Material/Labor 1Al�
New/Add SFs Remodel SFs Garage/New/Add F_—
OWNER'S NAME Last jI,I e First
_v
Owner's Address
Owner's E-mail Address
/
J�p
tT���\J (%�/�/�� n�` �^
City-F'"`�!-- Va F646+ State �—
V 1^ p
Zip JUW TelephoneV J �J _ Id(Q0
APPLICANT'S NAME Last I MW First ow I
Applicant's Address
Applicant's E-mail Address
iw .
f-rrm wno►r_si `v+c (ovyi
City IIV' State C
Zip 31 Telephone G�L�q ����)L4q
ARCHITECT/DESIGNER'S NAME Last
Lic. No.
First F I
Architect/Designer's Address
Architect/Designees E-mail Address
City State F_
—
zip F_Telephone�
ENGINEER'S NAME Last
First �— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State F___
Zip F_— TelephoneF—
CONTRACTOR'S NAME/COMPANY n
�Uh�l'SIG�S
Lic. No.FP/Wok Class
�Y1c
Contractor's Address
Contractor's E-mail Address
ti 3� 'G—Ke -WVj-
ts_ Iuna��i sLc
City 111AI, 16VW State FCk
Zip /J)/ 31 Telephone U 01
V+
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $