HomeMy WebLinkAboutXR2024-5896 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 0141
City of Newport Beach - Building Division Comm'I r ResidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading rDrainage F_Elec rMech F- Plum CuYdCut F CuYdFill t
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide rN/A Floor Suite No
\(k'S R o{� &W) CAV-.� F F__
of Work
New/Add SFF Remodel
OWNER'S NAME Last
Owner's Address
City
Use t ConstType t
# StoriesF_ # Units (if Res)t
Valuation $
Garage/New/Add �— Material/Labor
First
Owner's E-mail Address
State F_ Zip F_ Telephoned
APPLICANT'S NAME Last I First
Applicant's Address Applicant's E-mail Address
City I State F_ Zip F__ TelephoneF_
ARCH ITECT/DESIGNER'S NAME Last First —
Lic. No.
ArchitectlDesigner's Address Architect/Designer's E-mail Address
City I State �— Zip F Telephone
ENGINEER'S NAME Last First F Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F___ Zip F Telephoner
CONTRACTOR'S NAME/COMPANY OjlAW&HAt,,E iA0-if [�j ce,��'2,: i,•_,SicNo. 1t yd{rj Class
Contractor's Address Contractor's E-mail Address
2x6i Ht�(ZHr:A 5"9 CNftr'Ei✓dtL�, „2ci';iv�a .vim
City (Y1 y State F"'---
Zip q Z(J<l( Telephone TV 7/ 2 11,166
SETBACKS REAR SETBACKS FRONT PERMIT NO. XI\�Q���-It[J
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $