HomeMy WebLinkAboutXR2024-6165 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Valuation $
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OWNER'S NAME IC./lC Last �/L�/N.%G ��'F���'y First �/i%-%/'i7�/i.� G�r?�i%l'rr//UlTl�j
Owner's Address Owner's E-mail Address
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City / �-L' //�' State Zip `%ZG�/7 Telephone �f- �20-/�2(i'
APPLICANT'S NAME Last % �'�( i First AI
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last 1 A%//�/✓/ First /2AA/,[D / Lic. No. 2�Z�
Architect/Designer's Address Architect/Designer's E-mail Address
State Telephone
ENGINEER'S NAME Last First F_ Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State Zip �- Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. F_Class
Contractor's Address Contractor's E-mail Address
City State F__ Zip I Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.'�•
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $