HomeMy WebLinkAboutXR2025-0910 - Permit ApplicationC
Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division 1F
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
gBuilding F Grading ["Drainage r— Elec Mech
r Plum CuYdCut F CuYdFill
Project Address (Not mailing address) r Flood
j— Fire r Liq r` Landslide F_N/A Floor Suite No
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Description of Work
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# Stories # Units (if Res)F_
S
Valuation $ 2 �%� C^`
r J
New/Add SF �� Remodel SF $ Garage/New/Add
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Material/Labor
OWNER'S NAME Lead
First! ,tY,h2.. (-o,w`Izti.i A r i�+.chF Hcr.c>
Owner's Address
Owner's E-mail Address
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City �wrf �i Cu�.Vn State r-Gh
Zip FTE Telephoner —
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State r
Zip Telephone)
ARCHITECT/DESIGNER'S NAME Last :.6A Dp„ u
First "..,, Lic No. FC..'73Y'il
Architect/Designer's Address
Architect/Designer's E-mail Address
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City Lcy�,` Pqysc\ State I Ch
Zip I '3Telephone %i`I 2'i,j-'t6-/C
ENGINEER'S NAME Last {h
First F "/ - Li c No
Engineer's Address
Engineer's E-mail Address
City F_ State
Zip i� Telephone�_��
CONTRACTOR'S NAME/COMPANY <(; % p Lic. No. /oozzi5 Class A)g,
V" J
Contractor's Address
Contractor's E-mail Address
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City I Mt„i YSr_CL,\ State G/r
Zip gzie,Z-7— Telephone 71 I,!
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S