HomeMy WebLinkAboutXC2024-0356 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
O�EW=oR,m
---- I 9 pp
r Comm] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
jP4ilding F_GradingF-Drainage r-Elec rMech
F-Plum Cu rd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood
i- Fire i- Liq r Landslide r N/A Floor Suite No
Description of Work
Use F—ConstType
LV CA 5 tk RZ
16
Stories[— # Units (if Res)F—
0 u *
W-4 /
n $
Material/L rNew/Add �J
-Valuatio—
SF Remodel SF 00ScFt-Garage/New/Add
OWNER'S NAME Last [ * o b O oS
First d 5
Owner's Address
Owner's E-mail Address
i co P-w y
414,!5S F k,@ DG F vi�r- S. co-11
City WACO 0/v' 6 pA/ y State W—
'�//'_�,
Zi 7-
p (7 Telephone a,�_
APPLICANT'S NAME Last 1 Cj*-(,( _ f [ , �e First
/ (le
Applicant's Address
E-mail Address
City I State
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last Alf)( 6/&_t/fS FirstF— Lic. No.F—
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
,4 G G D � iv ( Oi- 0 G m f� c
r� CLIF—
City I V4-1c 1t a'✓ State (�-4
Zip q/ 3S Telephone Zt3
t
ENGINEER'S NAME Last
First F Lic. Nof—
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- ClassF_
Contractor's Address
Contractor's E-mail Address
City State F—
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.ZPl'ct-1
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $