HomeMy WebLinkAboutXR2024-6556 - Permit ApplicationPrint Form _ Worksheet for Combo Building & Solar Permit Application CORPF_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding j-Grading rDrainage rElec F_Mech
F-Plum CuvdCut F CuYdFill
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Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide I -N/A Floor Suite No
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Description of Work tlli >L %i �a=jF%y//'Tl/�l/ "� 7Oi>
Use 2��onstType -A
# StoriesO_ # Units (if Res)
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Valuation
Material/Laa bor j
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New/Add SF Sen�acYel SF Garage/New/Add e/New/Add
OWNER'S NAME/C,4 ,, -Ygt. /TLGij/t/ l E' l2+ i1 L%/Fitt � � / 1z l✓j OG�/�✓Ci C j�/
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Owner's Address
Owner's E-mail Address
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City i i- State 17' —
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z P �' / 7 Telephone a'T - 7 -� � ZG
APPLICANT'S NAME Last / �2 Jj j�
First
Applicant's Address
Applicant's E-mail Address
City State Cp
Zip % Z Telephone
ARCHITECT/DESIGNER'S NAME Last
Lic. !Z�
Architect/Designer's Address
Architect/Designer's E-mail Address
City Sta
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 Class
Contractors Address
Contractor's E-mail Address
City State F
Zip F Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X, 4)55 '
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $