HomeMy WebLinkAboutXR2024-5626 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application oF'E
r Comm" Residential City of Newport Beach - Building Division i
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o'°Re
'Building r Grading r-Drainage F Elec rMech
r Plum Cu vd cut Cu vd Fill F
Project Address (Not mailing address) i- Flood
r Fire r Liq i- Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType
# Stories #Units (if Res)
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Valuation 7 K
New/Add SF Remodel SF Garage/New/Add
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Material/Labor
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OWNER'S NAME Last o 1,4 t�
First
Owner's Address
Owner's E-mail Address
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City I State FL,�:
Zip �Z G G j Telephone 9 1t- 9 G 3- 17
APPLICANT'S NAME Last S'� Cs-v� J
First
Applicant's Address
Applicant's E-mail Address
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/ (2. i c t tACyt K ST.
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City State
Zip c L 3Telephone �y$ _
ARCHITECT/DESIGNER'S NAME Last
First Lic No.
ArchitectIDesigner's Address
Architect/Designer's E-mail Address
City State [--
Zip F_ Telephoned
ENGINEER'S NAME Last
First F Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY S�k C-/ Lic No. //o'77y 3 Class
Contractor's Address
Contractors E-mail Address 3 .0 e q V 6q
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L/ 2 3 Y `1 %� 1. 12 s'7�,
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City I A JJ L t T/� State I (T
Zip j / Telephone 9/y _ Z/ -�S �-
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $