HomeMy WebLinkAboutXR2024-6520 - Permit Applicationv
Print Form Worksheet for Combo Building & Solar Permit Application
r Comm'I R Residential City of Newport Beach - Building Division 16
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL q
ow.
Building rGrading F-Drainage F_Elec FMech
F-Plum Cu yd cut Cu Yd Fills
Project Address (Not mailing address) F Flood
r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F4f4 ConstType I/-9
�t mCtiL j (�L Icll-C LZl j�' tt ,t X'i,
# Stories # Units (if Res)s
` 1
d
New/Add SFF- Remodel SF jz Garage/New/Add
F-
Valuation $ t
Material/Labor { 1 a L L
OWNER'S NAME Last
First ifVmL l.z:�1Yln�
Owner's Address
Owners E-mail Address
City N' W : rl' S e= 44 State � A
('
Zip `j u E.. Telephone
APPLICANT'S NAME Last
First I y:1<,�
Applicant's Address
Applicant's E-mail Address
r� in.. �1CIt� 1'lVL. Un( r
City State LA
Zip gZ(az} Telephone%/�)?ry-+ /({ ,
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. (-
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F TelephoneF
ENGINEER'S NAME Last
First F Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City State F
zip F Telephones
CONTRACTOR'S NAMECOMPANY f4
Lic No. letZ2 I - Class L
r
Contractor's Address
Contractor's E-mail Address
JOE, li u,t,- /eve
-77, (� K6Zc r LO6—
City I State L%
ZipFE " L Telephone 7 q y biz . 5!c
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $