HomeMy WebLinkAboutXR2024-6608 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
( f-comm'I r'VResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FBGilding F_ Grading rDrainage r Elec r Mech r Plum CuYdCut I CuvdFill
Project Address (Not mailing address) i- Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work a Zt 4�}z Use PoaonstType
/-'i(C✓� ft Y 0/,-7 ce
# Storied # Units (if Res) i'
r r Valuation $ r
New/Add SFF �egaedeFSF 9 �% Garage/New/Add I Material/Labor
OWNER'S NAME /e- /L'-- n. <i v., z7f S
Owner's Address/ Owner's E-mail Address C
City State Zip Fes, J ^7 Telephone 7M - '%� ; — 'h ;� Ze,
APPLICANT'S NAME Last l � /F X First I L /n .,/
Applicant's Address Applicant's E-mail Address
City 1--�•'��f!* /SL�ix;✓`) State Zip li��/vl Telephone %�
-/� d� First /�
ARCHITECT/DESIGNER'S NAME Last /�j2 j �j/i)l,i�� /
Lic. N - � �7 72S"
Architect/Designer's Address Architect/Designer's E-mail Address /
f` —
City State id Telephone
ENGINEER'S NAME Last First F_ Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State � Zip � Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
City State F Zip
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
Telephone
PERMIT NO. �Q2�Z"l"`�b�
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $