HomeMy WebLinkAboutXR2024-1188 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application u4�Ew��=
City ew of Newport Beach - Building Division
fr Comm'I r Residential P 9
ti NOTE: PLAN CHECK FEES DUE AT TIME OF SURMITTAI
rBuilding rGrading rDrainage rElec rMech rplum Cu yd CutF_ Cu yd Fillf
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work Use lJ I ��� yP ConstT e
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Ntfo,IF StoriesT # Units (if Res)T
--il r'C3% �tr`151 t`t2csrv(1.&CC�Cil^'t
r Valuation $
New/Add SF pJe i Remodel SF �— Garage/New/Add I Material/Labor
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OWNER'S NAME Last
FQ First ' �[
Owner's Address Owner's E-mail Address
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City � C14 - - -_I State F ZIP Telephone b,,y _TM _I�215
APPLICANT'S NAME Last ``_
c�Af04e-r - _- First -54evQo
Applicant's Address Applicant's E-mail Address
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City State Zip Telephone
-_75_ _41 a=7sr-7_s
ARCHITECT/DESIGNER'S NAME Last First -
---- ---- - - - 07�_ Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
city I 1�;w�� VoutuA State Zip C� Telephone
ENGINEER'S NAME pilk Last First F Lic No.F-
Engineer's Address Engineer's E-mail Address
City - State ZiP F— Telephoned
CONTRACTOR'S NAME/COMPANY --rw Lic. No. �- ClassF_
Contractor's Address Contractor's E-mail Address
City State -! Zip �— Telephonel
SETBACKS REAR SETBACKS FRONT PERMIT NO.
OZaZy_ 8
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PC2OZ41-
USE ZONE DEVELOPMENT NO PLAN CHECK FEES$