HomeMy WebLinkAboutXR2024-6128 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�Ew�Rm
P-<'Omm'I F[,R'esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
F uilding i— Grading rDrainage r Elec i—Mech
r Plum Cu Yd Cutl Cu Yd Fill F_
Project Address (Not mailing address) r Flood
j_ Fire F_ Liiqq F-Landslidef N/A Suite No
rFloor
ke
/J61'1f O `� _ / `lam%��i CA F�f-
(Description
of Work al.4 . / /} ,jy-)At 6c
UseV /7"onstType v A
/Gr-ci%Y'r�b'"t r�,'g /2� L.ntL G%/�':-'' �
�� x G /'��- �.
# Storiesl Units (if Res) '
Ciwli/,1�rli /`d/���/�4_ fly
f. 4/4
r(d
Valuation $
Material/Labor �� �(/•
New/AddSF ��l ISF ;?,V G,,,F r Garage/New/Add I
OWNER'S NAME /CIdC_ '%ram Jret
f /`'/7, 7 /w tit% 77r!5'
Owner's Address
Owner's E-mail Address
City ) State ?
zip �P / Tele hone 7 _-f_
APPLICANT'S NAME Last �� t/ /� k
First �k
Applicant's Address
Applicant's E-mail Address
C E.2t
City �,JCi[ �2 /CGA/L,State I ` "'
ZiP j7�,k_7_ Telephone
ARCHITECT/DESIGNER'S NAME Last , " First � � t� 4 2
P'th i /��[-/ /a-,� � / Lic. N ` 2 ZZ -
ArchitecNDesigner's Address
Architect/Designer's E-mail Address
"i2/� /�S /�i'Sr✓�
City Sta
Zi Telephone
ENGINEER'S NAME Last
First �— Lit. No.
Engineer's Address
Engineer's E-mail Address
City I State �—
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F_— ClassF
Contractor's Address
Contractor's E-mail Address
City I State �—
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $