HomeMy WebLinkAboutXR2025-0538 - Permit Applicationt Farm Worksheet for Combo Building & Solar Permit Application 4>
Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V
(" Building r Grading ('"Drainage r- Elec r Mech f-- Plum
Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) r Flood f— Fire r Liq r` Landslide r`N/A Floor Suite No
of Work
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t,(��L� �G,i VAC
New/Add SFF � RemodelSFF � Garage/New/Add
Use I— ConstType l
# Stories7 # Units (if Res)[ —
Valuation $
Material/Labor WL, 0$$.
OWNER'S NAME Last - - -----
j3i J Lv First L
Owner's Address ' ' I
LLOwner's E-mail Address
City r f� State F_ F
i� Zi I �1�5 Tele hone �
P 1 P % f- q 3 C7 c. 6:
APPLICANT'S NAME Last ;�� 1 �C �.C- t� First G ..
Applicant's Address _ Applicant's E-mail Address
City �'� �: State -
ZIP I ( L Telephoned( 7( z.ZZ b'
ARCHITECT/DESIGNER'S NAME
Last FFirst F
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City I State
ZAP [� Telephone F�
ENGINEER'S NAME Last r____ �� Lic No.F�-
First
Engineer's Address E-
En Engineer's 9 mail Address
City State F— ZAP F� Telephone���
CONTRACTOR'S NAME/COMPANY C t L�
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Contractor's Address Contractor's E-mail Address
V % 7 1 ' (I- F L/C .__.
City 77 l%- State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
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Zip Cq���l� Telephone ( CII
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES S