HomeMy WebLinkAboutXC2024-0435 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential n ( City of Newport Beach - Building Division
/ \ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood j-- Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
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Valuation
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Material/Labor
OWNER'S NAME
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Owners Address
Owner's E-mail Address
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City
State �� Zip Telephone iv
APPLICANT'S NAME
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Applicant's Address
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I Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last 9p f o,-, d First — Lic. No.
ArchltecUDesigner's Address
Architect/Designees E-mail Address
City State �— Zip F__j 0 Telephonerr y-I �� j ' �s T6
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ENGINEER'S NAME
Last First F Lic. No f
Engineer's Address
Engineer's E-mail Address
City
State Zip TelephoneF
CONTRACTOR'S NAME/COMPANY �j / Lic. No. F__ ClassF
E-mail Address
Contractor's Address
Contractors I V
City
State l-- Zip �— Telephone[
SETBACKS FRONT PERMIT NO.�(iNti�.Vl%J
SETBACKS REAR
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. Cjp l 0 �7
USE ZONE
npvri nPMFNT mn PLAN CHECK FEES $ _