HomeMy WebLinkAboutXR2024-6490 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF9 °R
�6mm'I (�JF%sidential City of Newport Beach - Building Division
v NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Ft,auilding r Grading rDrainage r Elec r Mech r Plum Cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
TrL ' wiz R� zz
Description of Work UseF�R LonstType G 7,!i
� #Stories #Units (if Res)
Valuation $
New/Add SFF 6=FI / (' 5, Garage/New/Add �— Material/Labor i �C
OWNER'S NAME C= Last vv/ C LG'�t9`?i1rL .Sirs
Owner's Address Owner's E-mail Address
/7���'lyell
City �/ (/'jZ State :1_1 Zip 2-1( 1, Telephone ` 5,-
APPLICANT'S NAME Last I `�� C' /t X First I �._J A Y
Applicant's Address Applicant's E-mail Address
/1!/g"
City7 Telephone
/ILf.��C'jn.dd<''Li� State— Zip - I
ARCHITECT/DESIGNER'S NAME Last 12-AXII --First %.41VJ Lic. No ZZS'
Architect/Designer's Address Architect/Designer's E-mail Address
City
State77
Zip Telephone�—
ENGINEER'S NAME Last
Engineer's Address
First � Lic. No.F_
Engineer's E-mail Address
City State �— Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F— ClassF
Contractor's Address Contractor's E-mail Address
City ^__ State �- Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. tyzo i
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $