HomeMy WebLinkAboutXR2024-6424 - Permit Application__Print Form I Worksheet for Combo Building & Solar Permit Application
P__60ni Ft-Mesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
"uilding r-Grading rDrainage rElec rMech rPlum CuvdCut CuvdFill F
Project/Add esss (Not mailing address) r- Flood r Fire r Liq i- Landslide/ rN/A Floor Suite No
New/Add SF 13aaaedel SF I /1" S/ Garage/New/Add
US472�onstType VT-/,f
# StoriesF-� # Units (if Res)F
Valuation $
Material/Labor / Su"�
OWNER'SNAME��,AQ �/=l�i�'gG
Owner's Address Owner's E-mail Address
City j iffy State Zip 7Z%.� � Telephone � '— 77-�- `S -2�
APPLICANT'S NAME Last I Tpz �J ft j! First I J
Applicant's Address Applicant's E-mail Address
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City 7DiaL %??jiq /S C/,it/)� State �/3 Zip e'Z4 'Z Telephone %9l� . Z&O
ARCHITECT/DESIGNER'S NAME Last f %�% V' y I Z ' � %
I/y : First -//L'� Lic N
Architect/Designer's Address Architect/Designer's E-mail Address
City Sta ip Telephoned
ENGINEER'S NAME Last First— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State F_ Zip TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. I ClassF_
Contractor's Address Contractor's E-mail Address
City State � Zip F Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.)(%j0tq-6g2y
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $