HomeMy WebLinkAboutXR2024-6952 - Permit ApplicationPrint Form Worksheet for Combo Building& Solar Permit Application cam
pp
m'I �idential City of Newport Beach - Building DivisioNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Fe<u iIding rGrading F-Drainage F_Elec r-Mech rPlum cuYdCut [_ cuYdFill F_
Project Address (Not mailing address) r Flood r Fire r- Liq F- Landslide r_N/A Floor Suite No
Description of Work �/ /4i'-_�i5 jGyV z'� raj lrL
Use�onstTy
for G v r «N%J
# StoriesF7 # Units (if Res)
Al'o C 7/ t / /u o lAle /;ic 6lx,�, Ai' Z/L . AS /ZF Cv` ?�)
12-eesr- /�,
New/Add SFF— l;emodel SF ?r/ Z S` Garage/New/Add
Valuation$ JY/ �`y ;t
Material/Labor
OWNER'S NAMEE`CAL
/
Owner's Address Owner's E-mail Address
City %!Z. i 7t.,�i State 177 Zip Z Telephone y 2 Gjq ZG�
APPLICANT'S NAME Last (/ /L First 57
Applicant's Address Applicant's E-mail Address
City 9G �2j� /1 /CG j3 ry ; 7 State CA Zip (r�,Z Telephone
ARCHITECT/DESIGNER'S NAME Last � ,/�/t,) % First 7T A,,L//D / Lic. N _. -a
Architect/Designeft Address Architect/Designer's E-mail Address /
City Zip TelephoneF
ENGINEER'S NAME Last First �— Lic. No. F—
Engineer's Address Engineer's E-mail Address
City State F— Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY (�I,��ioha( p,(pn Lic. No. 1561�3 Class
Contractor's Address Contractor's E-mail Address
�11(e1 N. Dq\y S 4 Yttc�.b`�Y1���ohs1(C�10va}io„%nc.Carh
City Qyw\nem State C ( Zip j280G Telephone 41[51-2i5-I110
SETBACKS REAR SETBACKS FRONT PERMIT NO. x�� 77 4,-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $