HomeMy WebLinkAboutXR2024-6607 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application ogm).�
rmm'I F'�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) F Flood r Fire r Liq r Landslide I -N/A Floor Suite No
Description of Work 112 CA,'r {G/ j N" /77 w R-i S�e-,fa,Q/7&v
Use�L ConstType Fes-%
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# Stories # Units (if Res) �-
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Valuation $ iG
Material/Labor
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SF-lNew/Add SF R/2
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OWNER'S NAME C',4C{
Owners Address Owner's E-mail Address
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City �� State �1 Zip ,_� Telephone g-/-7,? c - �ZD
APPLICANT'S NAME Last �72 (,'i( L First C .
Applicant's Address Applicant's E-mail Address
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City L ��0 ��/. A;,,JO State t% ;q Zip Z Telephone 7%fe,f - z-6&,7; c� j
ARCHITECT/DESIGNER'S NAME Last First hti�i Lic.N
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Architect/Designer's Address Architect/Designer's E-mail Address
City S Zip Telephone�—
ENGINEER'S NAME Last First �— Lic. No.F—
Engineer's Address Engineers E-mail Address
City State �— Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. F_ Class
Contractor's Address Contractor's E-mail Address 7 L
City State F— Zip F— Telephonel—
SETBACKS REAR SETBACKS FRONT PERMIT NO. i.-1667
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $