HomeMy WebLinkAboutXR2024-6202 - Permit Application (3)Print Form
Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'SNAMEICA- mast)/^vllluC
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Use �6,ConstType -i
# Storiess # Units (if Res)
Valuation $
Garage/New/Add �— Material/La
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Owner's Address Owner's E-mail Address
City / fZ j,'</L" State CiS Zip F72�- 1' Telephone ; -
APPLICANT'S NAME Last I Tom[,' ✓ts First I \ J/
Applicant's Address Applicant's E-mail Address
City I J/1i l'i0/ �i�/n State I� n Zip l�Z�i.41 a Telephone < - �t
ARCHITECT/DESIGNER'S NAME
Last /Li First / � Aw D v Lic. No.
Architect/Designer's Address e / Architect/Designer's E-mail Ad/dress
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City
ENGINEER'S NAME Last
Telephones —
First F_ Lic. No.1—
Engineer's Address Engineer's E-mail Address
City State �— Zip �— Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
Lic. No. I Class
Contractor's E-mail Address
State �— Zip �— TelephoneF
SETBACKS FRONT
PERMIT NO,
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $