HomeMy WebLinkAboutXR2024-5636 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r�ld1ng r' Grading rDrainage j- Elec
Address (Not
of Work
r Mech F- Plum Cu Yd Cut Cu Yd Fill
F Flood F_ Fire F_ Liq F Landslide
rN/A Floor
Suite No
14
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New/AddSFF— Remodel SF7T_6_;0CJ__ Garage/New/Add
Use F Const Type F
# StoriesF # Units (if Res)
Valuation:5 u
F— Material/L / 6 r O[;'j
OWNER'S NAME Last I r) (1S First lr�
Owner's Address 11 4
a Owner's E-mail Address
city L 1 7 State c, l� zip �— Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City { 1 a, C� �(i q �t r{ _ f-� � L i%'C-6-CGI State �,{� Zip c Telephone S% _S -Q I
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F— TelephoneF_
ENGINEER'S NAME Last I First F_— Lic. No.F—
Engineer's Address Engineer's E-mail Address
City I State i— Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY F r T _ Lic No. 17-7 ' 3 (ass
Contractor's Address Contractor's E-mail Address
Ot FWFErA-6'l/lu wrs neon:
City F State pr Zip C( 76 d �� Telephone[ I S"
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, L
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $