HomeMy WebLinkAboutXC2024-0293 - Permit ApplicationPrint Form
t/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
r✓Building F_Grading
rDrainage r✓Elec r�ech
Plum CudCut[ CuvdrillF
Project Address (Not mailing address) I— Flood
P--6e r Liq r— Landslide rN/A Floor Suite No
1; F_
171 NSW PbL6�T�rL
DR -
Description
Description of Work
Use s ConstType s
# Stories #Units (if Res)s
G o t,\ ✓C-9-c l a-L, T
Valuation $
Material/Labor 0
New/Add SFF- Remodel SFF- Garage/New/Add Ir
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State
Zip F_ TelephoneF—
APPLICANT'S NAME
Last I PlFA-(L +L.E
First JA-j ,,)
0
Applicant's Address
Applicant's E-mail Address
1(,52 020 IvM
J4&t, HZ4C0. CoM
City 0CEAr�51 or,
State I�--Tt
Zip 412,?5(o Telephone ii; 76-a 3S`i`/
ARCHITECT/DESIGNER'S NAME
Last
First F Lic. No. �—
ArchitecYDesigner's Address
Architect/Designer's E-mail Address
7ZI )' eiti2 prvE
Sur'rC- _
City
State �—
Zip Telephone�—
ENGINEER'S NAME
Last
First Lic. No.s—
Engineer's Address
Engineer's E-mail Address
City
State F
Zip F_ Telephones
CONTRACTOR'S NAME/COMPANY �Zr►— LoNST-jLVCTIoLic. No. 96Sgg I Class
LS
Contractor's Address
Contractor's E-mail Address
i1o52 6Rp 4Ay
Jg50a Q HVC-Co.Co�
City D�rS106
State F�;—
Zip �2p5L Telephone � -766 35qt'J
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X GZ 02 '� ^ OZ 3
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.?CZ0Z'l Z3
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $