HomeMy WebLinkAboutXR2024-0148 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ��°
r Comm'I r Residential City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °�. M
rBuilding r Grading
Fl@lpaina Ix Elec rMech )( Plum cuYdCut F cuvdFill F
Project Address (Not mailing address) I— Flood r Fire r Liq r Landslide F_N/A Floor Suite No
921 Mariners Drive, Newport Beach F F
Description of Work
Use �ConstType
s, paipFwelIs, expanding
shower size, adding additional shower head, adding
Expand
closet si7a
# StoriesF # Units (if Res)F_
generator.
Valuation $ 000
New/AddSFF__
Remodel SFF—Garage/New/AddF
Material/Labor
OWNER'S NAME
Last rrheyen FirstID avis
Owner's Address
Owner's E-mail Address
921 Mariners Drive
verheyen@cleanroomsolutions.com
CityIN ewport Beach
State Zip 2660 Telephone 492740165
APPLICANT'S NAME
Last rerheyen First pavis
Applicant's Address
Applicant's E-mail Address
921 Mariners Drive
verheyen@cleanroomsolutions.com
CityIN ewport Beach
State F Zip 2660 Telephone 492740165
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �- -- Zip Telephone F_
ENGINEER'S NAME
Last First— Lic No.1—
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. I Class
Contractor's Address
Contractor's E-mail Address
City
State F__ Zip F_ Telephoned
SETBACKS REAR
Q
SETBACKS FRONT PERMIT NO. -W LA / tI D
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NOL Qe-" L �J
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $