HomeMy WebLinkAboutXR2025-0598 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application a E�Po9>m
City of Newport Beach - Building Division Ut
r Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
6(Building r" Grading T -Drainage F Elec r Mech
("'- Plum CuvdCut F_ CuvdFill F_
Project Address (Not mailing address) r Flood
(- Fire T— Liq T` Landslide FN/A Floor Suite No
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Description of Work
Use R-IT ConstType •13
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# Storiesr— # Units (if Res)F—
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Valuation $
Material/Labor
New/Add SF Remodel SF �L,� l: Garage/New/Add
OWNER'S NAME Last F
First /r ✓,h G COW �
�YN IOny�
Owner's A(ddressr�
Owners E-mail Address
City.,.. .^t-tc.cL,\, State (,�
Zip `� 2. � G U Telephone[��
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F
Zip I Telephone;
ARCHITECT/DESIGNER'S NAME Last; 1 7 `� l
Lcas6c, First « Lic. No. U E f
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
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City G.C.-.'i-q State F k
Zip 1 1262.7 Telephone -71'� Z'i`i -1� Lf
ENGINEER'S NAME Last
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City �— State ��
Zip �_ Telephoned
CONTRACTOR'S NAME/COMPANY �rV n
Lic. No. jC)� ZL ( S Class %� 6I
Contractor's Address
Contractor's E-mail Address
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City I / cCvqu.,-r nf", State CA
Zip cr Z C6c; Telephone ,-
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SETBACKS REAR SETBACKS FRONT
PERMIT NO, 2.7-�1�'aS� Qj
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S