HomeMy WebLinkAboutXR2024-6491 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
jr.eomm'I r,--Re-sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) I- Flood r" Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work l� tFL �� fi low 1ff n-A 7/_ 40LUse
PE7-Y/42onstType
# StoriesF--�# Units (if Res)
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Valuation 5�
Material/Labor
New/Add SF �� 1 SF 2j ��C` g F-
Gara a/New/Add
OWNER'S NAME fZ!/J/UF' /%lkT j!-F+rstA/ZIN/ (�Vtt/YfG NET!
Owner's Address Owner's E-mail Address
City / j/ State CAI Zip C2/. TelephoneF7;�F- 7Zp
APPLICANT'S NAME Last ��z G �I}t First
Applicant's Address Applicant's E-mail Adddreesss
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City State CA Zip � �2,6%Z Telephone —� —r�--
ARCHITECT/DESIGNER'S NAME Last Z j First !` ��'�i�%�' / ly?-fi/t,,�y Lic No
Architect/Designer's Address Architect/Designer's E-mail Address
City tate TelephoneF_
ENGINEER'S NAME Last First Lic. No.F-
Engineers Address Engineer's E-mail Address
City State �- Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F ClassF
Contractor's Address Contractor's E-mail Address
City State F Zip F_ TelephoneF_
SETBACKS REAR SETBACKS FRONT PERMIT NO. / &24::
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $