HomeMy WebLinkAboutXR2024-0194 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
Rr
r Comm] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j(Building rGrading rDrainage rElec rMech
lProject
rPlum Cu vd Cut Cu vd Fill
Address (Not mailing address) i— Flood
j- Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use ConstType�
# StoriesF_ # Units (if Res)[ —
f?t L. �2%9LL� Sr�s c�>L t�lc`I1>SuPc
Valuation $ �n ``New/Add
Material/LaborFlo,00
SFRemodel SF�Garage/New/Add �
OWNER'S NAME Last 7/4)Z/`Z, ' First
Owner's Address
Owner's E-mail Address
&/Y�2 6114 G/GU %W-
e
City 6 , State (1
Zip l� C j_ Telephone Gf�l
APPLICANTS NAME Last �clev First /
Applicant's Address
Applicant's E-mail Address
3:3 -751 fM&TTff
q
City 19,4 f RVIA G'/ State ,
Zip bZ� Telephone y`f�/
ARCHITECT/DESIGNER'S NAME Last �p-6-KM First iI S Lic. No. G/
ArchitecUDesigner's Address
Architect/Designees E-mail Address
.�,,�
,�Pz 1 c* J
City State F___
Zip F TelephoneF
ENGINEER'S NAME Last //fjh�
First F_ L i c. No. C 3J U17
Engineer's Address
Engineer's E-mail Address
City ,5 7-� �j ,;'� State
Zip '` 7�) Telephon�7/-J-53�;_ - ?tti
CONTRACTOR'S NAME/COMPANY
Lic. No. �— ClassF
Contractor's Address
Contractor's E-mail Address
City State F
Zip F-- Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x i O N
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 1 M40 ( 6
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $