HomeMy WebLinkAboutXR2025-0139 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application-ut%Cie
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .oa"
rBuilding r Grading rDrainage r— Elec r Mech
r Plum CuvdCut F CuYdFill
Project Address (Not mailing address) i— Flood
r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F ConstType
t1
C •e. k.:�^r�� I l .�v 13c0
\
# StoriesF # Units (if Res)F
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Valuation $ d L• --, + `t
Material/Labor
New/Add SFF__ Remodel SF � >rt _ Garage/New/Add
F—
OWNER'S NAME Last ,(}. f.; e,,e First , Cm , h
Owner's Address
Owner's E-mail Address
77t•(I \1C„me:?ec,� \
City I- 37,g, N• ( State f A
Zip dc t, 7 7 Telephone (IN-7) :i i�, — sh) l 6
APPLICANT'S NAME Last X- a.✓ First Gry�•, e\
Applicant's Address
Applicant's E-mail Address
City I— State
Zip F__ TelephoneF_
ARCH ITECT/DESIGNER'S NAME Last N\a t,Ke
First 7 ;,- Lic. NoT—
Architect/Designer's Address
Architect/Designer's E-mail Address
r
City 4-t. ;, , : �' _,k' �r State C ,
Zip F'17l Telephone
ENGINEER'S NAME Last
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractors Address
Contractors E-mail Address
City State F
Zip F TelephoneF
SETBACKS REAR SETBACKS FRONT
PERMIT NO. JL4'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $