HomeMy WebLinkAboutU2025-0169 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
(` Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r—Buildingr— Grading r"-Drainage r— Elec (— Meth Plum cuYdCut I CuYdFill
ect Address (Not
of Work
mailing address) [_ Flood (— Fire j` Liq r Landslide r_N/A Floor Suite No
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New/Add SFI RemodelSFIWS I Garage/New/AddI
OWNER'S NAME Last C-6;t h Pa (U f� First 1 14-7
Use F— ConstType
# Stories7 # Units (if Res)[ —
Valuation $ 20
Material/Labor
Owner's Address Owner's E-mail Address
City I W"a z( df vtp�_----- State C k4_ Zip t / I o^ � Telephone 2 j 3
APPLICANT'S NAME Last l CXL iv
Applicant's Address
City �/��LI� State
� First #/,V A
Applicant's E-mail Ad/dress
Zip �l _� Telephone_ C/_-c/
ARCHITECT/DESIGNER'S NAME Last I First
Architect/Designers Address Architect/Designer's E-mail Address
City I State ^ Zip I TelephoneF
ENGINEER'S NAME Last I...___Y__v._-__.__.__ First
Lic. No. I
Engineer's Address Engineer's E-mail Address
City State F_ Zip I Telephoned
Lic No.1
CONTRACTOR'S NAME/COMPANY 1 ��6 %J � / � C- Lic No. ��1��^0 Class
Contractors Address ` Contractor's E-mail Address
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City / /I � y�" C � State % — Zip �ji�4 Telephone y�.Cj
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT rr PLAN CHECK NO.
USE ZONE DEVELOPMENT NO to__ D ),`-t- D_&_ - PLAN CHECK FEES S