HomeMy WebLinkAboutXR2024-1086 - Permit ApplicationPint Form Worksheet for Combo Building & Solar -Permit Application
Comm'] i- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FBuild,ing r Grading F-Drainage F_ Elec r Mech F_ Plum cuYdCut I CuYdFill
dress (Not mailing address) F_ Flood
r Fire f
Liq�/�zr- Landslide rN/A
Floor
� �1 � 1` Uh t f . .ct�_ � i? ar
�
(i 4.
New/AddSFF Remodel SFF— Garage/New/Addr
Suite Nc
Use Cono ype
# Stories Units ' es)F
Valuation $ �l
Material/Labor
OWNER'S NAME Last (�� �� �I l_ J�'T C � First W__r P_T (&3 eq /� ✓1 /��'��t
Owner's Address "1 Owner's E-mail Address /
City i '( �d6u (1q State Zip 5' 9� Telephone—
APPLICANT'S NAME Last NVA S First l-j F��A r— G
Applicant's Address
G 1�7- Daly 114)
City �j,�l StateJ
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
Applicant's E-mail Address
Im aP Ti �6v1 Gu t` ✓i 4� J+' [>P1 i vl� CO -
—� [
Zip S�L 5, Telephonelf4—
First
Architect/Designer's L-mail Address
City I State �— Zip I— Telephoned
ENGINEER'S NAME Last �First FI IpoEnT0 Lic.No.F
Lic No,
Engineer's Address
A� A- 4 0 - 9 k 1 �LLA ST,
City �R� State
Engineer's E-mail Address
Zip qZ' e,�7, Telephone -14) �cf 145
CONTRACTOR'SNAME/COMPANY Il���'1 lk7iV�712V��16N ����- Lic. No. Q(C(l Classy
Contractor's Address
i '3
City V �i State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address 11iRrli6 MCtVCiLOyn5firoJIDr1 -C-0
Zip Telephone ��t� 13 — f 3 C) j
PERMIT NO. X f M y• I Og6
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $