HomeMy WebLinkAboutXR2024-0200 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
V11-<o mm'I F`l,4esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r'r. uilding [- Grading [—Drainage [- Elec [- Mech [- Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing addresss)r[- Flood [- FireF_ Liq [- Landslide [-N/A Floor Suite No
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Description of Work ���� G/�dl=r� _!•!✓i/t rG Z �22/ l��
UseFY CanstType V
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If Stories��#-Units (if Res)
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Valuation $ p0
Material/Labor
New/AddSF� /Garage/New/Add
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OWNER'S NAME Last -7'_1 2/1IN & First
Owner's Address Owner's E-mail A
City State Zip F—Telephoned
APPLICANT'S NAME LastFirst
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Applicant's Address Applicant's E-mail Address
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City ,cjZ/aN/, State I �--�" Zip�Z Telephone
ARCHITECT/DESIGNER'S NAME Last /{/t1/1 L% First Lic No-71t�Z-1
Architect/Designer's Address Architect/Designer's E-mail Adddress
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City State Zip Telephone
ENGINEER'S NAME Last First F— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State I Zip I Telephoned
CONTRACTOR'S NAME/COMPANY C2 /� Lic No. 6'u'S Class�lC
Contractor's Address Contractor's E-mail Address
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City State C.7� Zip F Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. /mil
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PC 2aZq, ()1 70
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $