HomeMy WebLinkAboutXR2024-6671 - Permit ApplicationI Print Form Worksheet for Combo Building & Solar Permit Application
i— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage rElec r Mech r Plum CuvdCut CuYdFill F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide r N/A Floor S/uuiite No
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Description of Work
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Use�LConstType
# StoriesFF # Units (if Res) ;
%ZzCGa24VY 410 G AGE �%ny, ��r� x 0 /. /3Rij
Valuation $ !
Material/Labor 0 ,
fj����r Q,
New/Add SFF _&S;' SF 7rr y-`I ; Garage/New/Add �—
OWNER'S NAME
Owner's Address Owner's E-mail Address
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City State FCA Zip C-4 / 7 7
Telephone / - 7 Z/7 f f zZ�
APPLICANT'S NAME Last T%r (% /l �C First FAI
Applicant's Address Applicant's E-mail Address
City �-7-�./3eJ+ `� � State 1 ` Zip zZ/ # �f Telephone /�9- ��/%�
ARCHITECT/DESIGNER'S NAME Last (107 L I%,OJy / First py ��� Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
J 4' del A d V
City State Zip Telephone�—
ENGINEER'S NAME Last First Lic. NoT—
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY Lic.. No. Class F_
C
Contractor's Address Contractor's E-mail Address �
City �— State F Zip F— TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO. -
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $