HomeMy WebLinkAboutXR2024-6555 - Permit ApplicationPrint Form_ -I Worksheet for Combo Building & Solar Permit Application
�Tm'I residential City of Newport Beach -Building Division U
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
fA'uilding rGrading rDrainage rElec rMech
rPlum cuvdCut cuYdFill
Project Address (Not mailing address) f Flood
r Fire r Liq r Landslide rN/A�Floor Suite No
I �/
Description of Work L tC7L/`7 /zY<'T d� �D�
�� 0%'�? %%/Jf/
Use 2TUConstTYp e
,/ G
# Stories # Units (if Res)
/�crIZ /219.y..
Valuation$? %� ,-,c
acte�tSF�
New/Add SF�t;e 2 S Gara
g a/New/Add
Material/Labor
OWNER'S NAME '
G�CL� /,2 ��,�-� ��,�_-Ptr
Owner's Address
Owner's E-mail Address
?�/ / /-4-r,4Z-,V
City ( "l/lam State
Zip �Z� � Telephone 9�—%Zll/--�� -7 �J
APPLICANT'S NAME Last 12—V A jc
First jl
y
Applicant's Address
Applicant's E-mail Address
�� ��Z C��_7�t LOiU �G i�G� �
Li?t �C t� ��. G✓'f/G'0�-- CGl1r?
City /3p L A,QA /r� (A,v State C/{
Zip 72G , 2 TelephoneF/ �— -�-6 y —
ARCHITECT/DESIGNER'S NAME j� �--
Last (`—��; ��_/ First /Z ffif/c� Lic. No `Z� 2
Architect/Designer's Address
Architect/Designer's E-mail Address
^
City St
p
ENGINEER'S NAME Last
First F__ Lic. No.7—
Engineer's Address
Engineer's E-mail Address
City State I
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. I Class
Contractor's Address
Contractor's E-mail Address
City � State I
Zip Telephone F_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X e2-W2 `'I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $