HomeMy WebLinkAboutXR2024-0707 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
V6omm'I FlAke'sidential City of Newport Beach - Building Division a `
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL „tea s
�ilding F_Grading F-Drainage [Elec r-Mech r-Plum CuYdCut F_ CuYdFill F_
Project Address (Not mailing address) C Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work -g Zrn SON
Use�(/Const Type FF
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# Stories # Units (if Resf-_�-
�-lti1D' Y �' �-� fyr. J �/ � � b
Valuation $
Material/Lahor.
5:?PdjA T7,0n
New/Add SFr adiSF c�'7� f Garage/New/Add �-
OWNER'SNAMI�/ jC �l.ast 1/Z1/!l(i C,4h'%pjQ7Ut First //r d
Own/er's Address Owner's E-mail Address
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City /%2(//N' State FrA Zip _7 7 Telephone ��7
APPLICANT'S NAME Last 7�C/A1)c First
Applicant's Address Applicant's E-mail Address
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City %5/ Z_/5O,Q �� State j Zip 9�6 2 Telephone � �4
ARCHITECT/DESIGNER'S NAME Last / First %2�Nl�V Lic.N
Architect/Designer's Address Architect/Designer's E-mail Address
1. A
City Zip Telephone
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Address
City State Zip F Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class
Contractors Address Contractor's E-mail Address
City State �— Zip Telephone�—
SETBACKS REAR SETBACKS FRONT PERMIT NO. 20Z14' 070'7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PC7_07.t{-05S
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $