HomeMy WebLinkAboutXR2025-0195 - Permit Application_ Print Form__ j Worksheet for Combo Building & Solar Permit Application o4cEQ�R.m
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r7Elec ^ech
p'Plum CuYdCut F CuYdFill
Project Address (Not mailing address) F_ Flood r Fire r Liq r/ Landslide rN/A Floor Suite No
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Description of Work ' X
Use F—ConstType
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# Stories[— # Units (if Res)F_
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d^ i� �� c.�'<'n ��)c: 14j 7"Lt �.
New/AddSFF__— Remodel SF Garage/New/Add
Valuation $ t
Material/Labor
OWNER'S NAME Last 41
Owner's Address
Owner's E-mail Address
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City IL L-V Ply f J'��G, G(1 State 7A
Zip Telephone %L rC�
APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
City I State I
Zip F_ Telephonel
ARCHITECT/DESIGNER'S NAME Last �
First F_ �—
Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F— Telephoned
ENGINEER'S NAME Last
First 7— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I State F—
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY �rjhnvmj
(hOlJ 7�hS Lic. No. lea Class
Contractors Address
Contractor's E-mail Address
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City y ' ts,Gn State _ U'
Zip -ldb� � Telephone �/ q,6;_2 V71 y
SETBACKS REAR SETBACKS FRONT
PERMIT NO. nzoZS- C 457
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $