HomeMy WebLinkAboutXC2024-0235 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division m
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL R
�? Building r Grading rDrainage r Elec r Mech r Plum cuYdCut F CuvdFill
Project Address (Not mailing address) r Flood r Fire i— Liq r Landslide rN/A Floor Suite No
20�-
Description of Work I <_
Use F ConstType F
-n[_L1�� r�m�e �(�'` •t, %�I L, f �z fix, s'�, ry =
#Stories #Units (if Res)
New/Add SFF_— Remodel SF Garage/New/Add F
Valuation$ //' •�
Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City dt v LLl y 'l v OV' State C 71 Zip Gam{' f,L Telephone / jr a�� l — ,'3bl L
APPLICANT'S NAME
,s h�
LLast
Applicant's Address ��17�1, S� 4 ���Z.� Applicant's E-mail Address
City -F jr1✓6LPfI +-1r"1 v�_ State p� Zip T 3Sl� 1 Telephone ' 7/c/
ARCHITECT/DESIGNER'S NAME Last �First ` Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F— Zip F TelephoneF—
ENGINEER'S NAME Last A�i /4 First F_ Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State �— Zip F_ Telephonel—
CONTRACTOR'S NAME/COMPANY r /���C �c f y % y Lic No. �j f� Iyclass�
CJ`tr
Contractor's Address Contractors E-mail Address
City State F— Zip F_— TelephoneF_
SETBACKS REAR SETBACKS FRONT?•0 IJ PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ®,®
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $