HomeMy WebLinkAboutXR2024-6616 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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jU,guilding I- Grading F-Drainage r Elec r Mech r Plum CuvdCut CuYdFill
Project Address (Not mailing address) f Flood r Fire r Liq r Landslide N/A Floor Suite No
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Description of Work IWz-�i /12< Us,lfCVA 14�,U Td7zA770-t
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Use LConst Type v -Q
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# Stories% # Units (if ResQ5
Valuation a 2 pa
Material/Labor / q
New/Add SF F— ��'� J L' G
�/ > Garage/New/Add
OWNER'S NAME ,
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Owner's Address Owner's E-mail Address
City /tLv-/,ZZ State �— Zip -7 Telephone 7,,O% - 724 .- S �!2o
APPLICANT'S NAME Last �j2-(/fQj� First fyy
Applicant's Address Applicant's E-mail Address
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City ut A s[ AA,State r� Zip 77F Telephone 7��l
ARCHITECT/DESIGNER'S NAME Last �/W / �iQif//��Q_f First �A�/j�� Lic. N . - 24 2 2�
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Architect/Designer's Address Architect/Designer's E-mail Address
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City State ip Telephone
ENGINEER'S NAME Last First Lic. No.F--
Engineer's Address Engineer's E-mail Address
City State F Zip F_ Telephoned --
CONTRACTOR'S NAME/COMPANY Lic. No. F ClassF
Contractor's Address Contractor's E-mail Address
City State r Zip �— Telephoned!
SETBACKS REAR SETBACKS FRONT PERMIT NO. X Ii"1V1,L_q
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $