HomeMy WebLinkAboutXR2025-0836 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j Iyy Residential City of Newport Beach - Building Division
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X NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Ad/dre+ss (Not mailing address) (— Flood r` Fire j` Liq i— Landslide r-N/A F�loorr Suite No
17 J
Description of Work
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New/Add SFF_ Remodel SF F3 J(-
OWNER'S NAME Last
Owner's Address
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Use R 7 ConstType -(Q
# StoriesF_ # Units (if Res)F_
Valuation
Garage/New/Add Material/Labor
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Owner's E-mail Address
State (7� Zip QZ��,�, Telephoned
APPLICANT'S NAME Last I First I
Applicant's Address Applicant's E-mail Address
City State r Zip Telephones
FirstVLic. No. �ARCHITECT/DESIGNER'S NAME Last TET}� oF1,t�
Architect/Designer's Address Architect/Designer's E-mail Address
city rjC5,. State (�/k Zip q-262'7— Telephone )/� Z1`r-�G>'�c
ENGINEER'S NAME Last
FlrstF_ Lic. No.1
Engineer's Address Engineer's E-mail Address
City [� State Zip Telephone
CONTRACTOR'S NAME/COMPANY �Lic No. /Cie 22 S CIassF_ h�2 �r�vl�
Contractor's Address Contractor's E-mail Address
City State �_ Zip Telephoners
SETBACKS REAR SETBACKS FRONT PERMIT NO. 7CR?OZS- O %30
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S