HomeMy WebLinkAboutXR2024-0837 - Permit Application_Pent Form _I Worksheet for Combo Building & Solar Permit Application
F Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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rBuilding j-Grading F-Drainage XElec FMech Plum CuYdCut F CuvdFill F_
Project Address (Not mailing address) r Flood f Fire f Liq F Landslide f N/A Floor Suite No
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Description of Wo ielt f
ConstType
tUse
#Stories #Units (if Res)
valuation $
Material/Labor
3(0
New/Add SFF— Remodel SFF� Garage/New/Add �—
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OWNER'S NAME I/
Last g�H R e, First ;,(
Owner's Address
Owner's E-mail Address
City 41 &w Pu,r fie r. k) State /
Zip )66� Telephone
APPLICANT'S NAME Last /��,"",.,
' �►;'T' �i First PLY. ,1
Applicant's Address
Applicant's E-mail Address
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City 4aN h %I�H9f:✓1:C. State �— Zi '-7 P
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ARCHITECT/DESIGNER'S NAME
Last First
d�V G'YC� �hv,s LicNo.F�
Architect/Designers Address Architect/Designer's E-mail Address
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City ?Z1, iMLy.ei State I E ,ZiP 96%*S Telephone y
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ENGINEER'S NAME Last hu to First EY Lic. No.
Engineer's Address Engineer's E-mail Address
City L 4�"Telephone
�rGst �Ot� State ZiP ! 6 0 P -7 t�
Tele hone ��-�L,��
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CONTRACTOR'S NAME/COMPANY�GdjLic No. l i i ?a96i Class-��
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Contractor's Address
Contractor's E-mail Address
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City l� n L/& htt,a 12 State Zip Telephone qi S�
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SETBACKS REAR SETBACKS FRONT PERMIT NO. Q
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $