HomeMy WebLinkAboutXR2025-0297 - Permit ApplicationPrint Form
i`vt`omm'I r
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
9-4
Building j- Grading j-Drainage r Elec r- Mech
iW Plum CuYdCut F_ CUYdFill
Project Address (Not mailing address) i- Flood j- Firer Liq r- Landslide r`N/A Floor Suite No
GZ4�J` /ZeS JJe� U\ � �(% r
, � �Z661� Sr ��s
Description of Work
use I Const Type
�r
In a / /S � '/I- O C//' TO(l i CAS
# Stories # Units (if Res)[
a-r�
Valuation $ /
Material/Labor 6
��-! /j /T- Garage/New/Add I
New/Add SF Remodel SF / .�..�,� j"""`""""""`-""
OWNER'S NAME Last
First r✓�iw spa✓�mf'Y�ri" (�M�hJrr//7-es
Owner's Address
Owner's E-mail Address
550 Podpocd- CevtkC
State C
City tra f� QfAC .�
Zip Y� Telephone ��J
APPLICANT'S NAME Last _7'_i , o
Fo First I'VeA
Applicant's Address
Applicant's E-mail Address
o ontsl� ctdteacnSd{zx�idr .
City Z ff Sc�( State
Zip TZTelephone 741_5`.-3-6�Y((;
_
ARCHITECT/DESIGNER'S NAME Last !'r
First � n �
1!'-� Lic.No.�
Architect/Designer's Address
Architect/Designer's E-mail Address
City I � State F—
Zip I� Telephoned
ENGINEER'S NAME Last r
First Lic No.F_
Engineer's Address
Engineer's E-mail Address
City State �—
Zip �� Telephones
CONTRACTOR'S NAME/COMPANY 6„e- SAP n� I (41,A -vc- bn T Lic.No. D/S JO Class
!t "`W
�Address
Contractor's Address
UJ/ wN, 0l�fw,. �'✓-�
C00%mantracccttor''ss7E-mail
l
/"Z/�Z-�Y��O �!�%'�'is� �v1JL%�/�/i�TJt-�i(,�
City State FTT_
(A
Zip 9Z Z '7-- Telephone yjy-��y-L/,57
SETBACKS REAR SETBACKS FRONT
PERMIT NO.'L.C2j
SETBACKS LEFT - SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S
DYh
ciyL