HomeMy WebLinkAboutXR2024-0719 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application 0,�-mF
City of Newport Beach - Building Division
r Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading
r—Drainage rElec rMech
r Plum CuYdCut CuYdRIIF
Project Address (Not
mailing address) r Flood
r Fire r Liq r Landslide rN/A Floor Suite No
3) 0 Fe4M1-do
S �1
F_ F—
Description of Work
Use F_ConstType
# StoriesF_ # Units (if Res)[
Valuation $
Material/Labor
New/Add SFRemodel SFF— Garage/New/Add F—
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State �—
Zip F— Telephoned
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
city I
State F—
Zip F— Telephoned!
ARCHITECT/DESIGNER'S NAME Last
First Lic No.
Architect/Designer's Address
Architect/Designers E-mail Address
City
State F__
Zip F TelephoneF_
ENGINEER'S NAME
Last
First F__ Lic. No.F_
Engineers Address
Engineer's E-mail Address
City
State
Zip Telephone)
ONTRACTOR'S NAME/COMPANY l II h� F U.hs twL i C Lic. No. ( 44 S� Class
1 1 1 F
Uti
Contractor's Address
Contractor's E-mail Address
ey ICk@ dAtry\ CONASAruc�Icmof+ co v,
City Sa A2 Ara State I E�
Zip ( 7 U f( Telephone 7 N . 9 23.-1 S 03
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. &Z0Z4 —Q�
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. PGZUZU
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $