HomeMy WebLinkAboutXR2024-6654 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o4c�"°am
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
P<Building r Grading
[—Drainage rElec rMech
rPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
r Fire r Liq r Landslide I —N/A Floor Suite No
tc:1i I �e_SI e,IrlC._W' ,
I ' �—
Description of Work
Use �fv ConstType 1i
(If; C%,ir fP,-4Ni h
L -r ;r' L-,Yf_ Ih Wall v.w�
(Z:11m.. ah �d a�klPc:..,
IF Stories? # Units (if Res)-
Valuation $ y ?
Material/Labor I; i J • C)
New/Add SFF— Remodel SF �P Garage/New/Add F—
OWNER'S NAME
Last �f Nti1 /
I r
First
Owner'sAddress
Owner's E-mail Address
City tWPyr} �,w
State A
zipj 116c,(2 TelephoneF—
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I
State �—
Zip I TelephoneF—
ARCHITECT/DESIGNER'S NAME Last itk.r.:��
First Ryah Lic. No. (;-�JC j,�
Architect/Designer's Address
Architect/Designees E-mail Address
Qy 3 /An, F,.,;, {�vUJL
� ,., 6c, VRu
City �c`stC. l"1e1��
State (.rk
Zip 12L Z F Telephone (71-0 2_'N-'jos u
ENGINEER'S NAME
Last First F_ Lic. No.r
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip F— TelephoneF—
CONTRACTOR 'SNAME/COMPANY
Lic. No. IF Class j
i
Contractor's Address
Contractor's E-mail Address
F`l
City I NGwr^Y I)Cst�
State FLA
Zip 92C,/mac, Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES S