HomeMy WebLinkAboutXR2025-0015 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I f<Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�Building r Grading rDrainage j-Elec j-Mech r Plum Cuyd
Project Address (Not mailin
it r j _� I Pe-j'
of Work
r Flood i- Fire r Liq r Landslide
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New/Add SF i Remodel SFFL/ c� r
Cu Yd Fill I
rN/A Floor
Suite No
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Use F_ConstType
# StoriedF�7 #Units (if Res)
Valuation $
Garage/New/Addl — Material/Labor 10,c"o
OWNER'S NAME Last l S_J_0 ,� First l 1 G, 0
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Owner's Address Owners E-mail Address
City �/Vt t0 �# rXao� State Cit- Zip q AGSCT Telephone ` t- 275
APPLICANT'S NAME Lastl 7c'Sz_rvc First 4,, [
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Applicant's Address Applicant's E-mail Address
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City tct `` State `% , Zip y2`ej f Telephone 9+{ 1 -63C -- G 1 9 5
ARCHITECT/DESIGNER'S NAME Last First F Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F TelephoneF
ENGINEER'S NAME Last 1cS�l Y-, First Lic. No. -f52z',
Engineer's Address Engineer's E-mail Address
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City c;w. r-� State Zip ci Zf�4 S Telephone yl4 _ c7/ 7 _ V / L L
CONTRACTOR'S NAME/COMPANY
Lic No. 76 CFS j Class
Contractor's Address Contractors E-mail Address
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City I L jf, e&_[, i?,r_;,,e,C, State T*�- ZIP )'ZC9 y Telephone q?qq _E is G • CI`j-
SETBACKS REAR SETBACKS FRONT PERMIT NO. K22n2S - OnVS
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $