HomeMy WebLinkAboutXR2025-0008 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`rBuilding r Grading rDrainage j—Elec rMech
j—Plum cuvdCut F cuYdFill
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Project Address (Not mailing address) i— Flood
r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use ConstType
# StoriesF # Units (if Res
77
New/Add SF � Remodel SF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME Last
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First 1jGi�-/.-tCir-i^c'_
Owner's Address
Owner's E-mail Address
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city % . Z / f fGct - ! State L r
Zip �fLt/� Telephone G
APPLICANT'S NAME Last tl-Z<<o b-
First
1Address
Applicant's Address
Applicant's E-mail
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f� lief; af% t ' P� (-'i t� �i+I�'(J'� rTCh';�✓i_r _;
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City LCi�L °(4 5 State C f/
Zip � Telephone %�l?- (l�l —72W
ARCHITECT/DESIGNER'S NAME Last ��� c\, e
First Lic. No. �—
ArchitectlDesigner's Address
Architect/Designers E-mail Address
City State I—
Zip� Telephone�—
ENGINEER'S NAME Last
First F__ Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State F
Zip Telephone
CONTRACTOR'S NAME/COMPANY
>n }- Lic. No. J Class f-' 77
Contractor's Address
Contractor's E-mail Address
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City ���� ((�•�t.� State
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. xCzO-Z
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $