HomeMy WebLinkAboutXR2025-0628 - Permit Application1_ Print Form Worksheet for Combo Building & Solar Permit Appi'
om� m'I R€sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL r65
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Project Address (Not mailing address) (— Flood r Fire r Liq r Landslide �N/A Floor ui" two No
Description of Work f1�7C
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Stories # Units (if Res)
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Material/Labor
OWNER'S NAME (/C/d16- Last %�/ CC%I /yJ4tl� c=nst /ry�f1/�J!/C9�''k, /T�;wLp S
Owner's Address Owner's E-mail Address
City s� i//�1/ State F7,A Zip . _ Z(a Telephone %F - u y v
APPLICANT'S NAME Last I � fL &/A x First I �—J/, /
Applicant's Address Applicant's E-mail Address
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State F7 Zip /7GaG°Z Tele hone /
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ARCHITECT/DESIGNER'S NAME Last /2/t /b i ell— / First ( All, • "7 Li / / Lic. N
Architect/Designer's Address qq Architect/Designees E-mail/Address
City a e TelephoneF
ENGINEER'S NAME Last First F Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephones
CONTRACTOR'S NAME/COMPANY Lic No. F Class
Contractor's Address Contractor's E-mail Address
City State F___ Zip I-- Telephoned
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $