HomeMy WebLinkAboutXR2025-0055 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r comm"Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading rDrainage KElec �Mech
ly plum CuYdCutF cuYdFill
Project Address (Not mailing address) F_ Flood
F_ Fire j— Liq r Landslide F_N/A Floor Suite No
302. V iS�q S Q ecte-
F � —
Description of Work
Use F—ConstType F-
# StoriesFy # Units (if Res)F_
11
Valuation $
Material/Labor S�C7Q�
New/AddSFF_ Remodel SFF— Garage/New/AddF—
OWNER'S NAME Last �`\4,
First
Owner's Addresses
Owner's E-mail Address
9
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� State I
Zip Telephone a23 Li-oibi
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APPLICANT'S NAME Last a\l
First (�\A
Applicant's Address
Applicant's E-mail Address
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City � Vkcl& f� State I /}.
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Zip vk,' , I Telephone 5(v� �GGj 1 _CfQ)O1
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No.F
Arch itecUDesigner's Address
Architect/Designer's E-mail Address
City I State
Zip F— Telephoned
ENGINEER'S NAME Last
First 7— Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State F—
Zip F_ TelephoneF_
CONTRACTOR'S NAME/COMPANY s � Lic No. v U IS Class
Contractor's Address
Contractor's E-mail Address
Cqy:7-
City State �—
Zip Telephone�—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ifta).5
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $