HomeMy WebLinkAboutXR2024-0823 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A I on ozEW�am
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r Comm'I r Residential City of Newport Beach -Building Division -� „�q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building r- Grading r-Drainage r Elec r Mech
r Plum cuvdCut s CuvdFill s
Project Address (Not mailing address) i- Flood
r Fire F_ Liq r" Landslide rN/A Floor Suite No
Lo Vocc lo a
Mir CA I
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Description of Work
Use Const Type s
# Stories # Units (if Resf
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Valuation $�
Material/Labor
New/AddSFF— Remodel SFF—Garage/New/Add
OWNER'S NAME Last f l Gt k-h (�
First I C-f"�3
Owner's Address
Owners E-mail Address
City F_ „ ro�A 61 I\,{�� State CA
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Zip �LZ�i� Telep honeF_
APPLICANT'S NAME Last r�>h
First ,
Applicant's Address
Applicant's E-mail Address
t�,V Q Ii.16qu(rlotk
City 7\-) - - L State C { Zip Cijl 7 / /,i, Telephone 7/y
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ARCHITECT/DESIGNER'S NAME Last �— Lic. No.
Fiirr�st F_ F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip F_ Telephones
ENGINEER'S NAME Last
First Lic. No.s
Engineer's Address
Engineer's E-mail Address
City State �—
Zip F__ TelephoneF__
CONTRACTOR'S NAME/COMPANY / G t� JC u C Lic. No. q)-qq To Class
l•
Contractors Address
Contractor's E-mail Address
Ig,�7' iJ C�lc 0fic�
City y i%< State
Zip Telephone
rr3Lc L- ci - 7
SETBACKS REAR SETBACKS FRONT
PERMIT Wor
SETBACKS LEFT SETBACKS RIGHT
PLAN CH 0
USE ZONE DEVELOPMENT NO
PLAN CHE FEE