HomeMy WebLinkAboutXR2025-0721 - Permit ApplicationPrint Form / Worksheet for Combo Building & Solar Permit Application
F Comm'I V Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building f— Grading j—Drainage
r Elec (" Mech r Plum Cu Yd Cut F_Cu Yd Fill F_
Project Address (Not mailing
address) F Flood r Fire j " Liq f Landslide r_N/A Floor Suite No
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Description of Work
Use I ConstType F_
# Stories # Units (if Res)F
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f P� h/A �a/ !�
o irrlrt�afion a-s
Valuation $ {�
Material/LaborF2,t0, 7 3
New/Add SF F_Remodel SF Q ��f Garage/New/Add
OWNER'S NAME Last
First —....-_..__...
Owner's Address Owner's E-mail Address
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City 1LAG
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State F j Zip fj2L60 — Telephone Z-3) 14 Q— Q,5 Qq
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APPLICANT'S NAME Last I / rr�arl�v First ne
Applicant's Address
Applicant's E-mail Address
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City 1. Aye
q� State Zip ! ZCZ _7— Telephone Y4 I O(— 175//
ARCHITECT/DESIGNER'S NAME Last
First ng-CA Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip [ Telephoned
ENGINEER'S NAME Last F—
First Lic No.F—
Engineer's Address
Engineer's E-mail Address
City r—
1
State Zip � Telephone[ —
CONTRACTOR'S NAMEICOMPANY
Lic. No. I 1Qf1 J" 30 Class
>> (..4Contractor's
Contractor's Address
E-mail Address
city
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State � Zip fZCLV- Telephone T y�t—?✓!ff
SETBACKS REAR SETBACKS FRONT PERMIT NO. )M=5 — TZ
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S
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