HomeMy WebLinkAboutXR2025-0140 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application @09P
(— Comm'I (— Residential City of Newport Beach - Building Division
NOTE:PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding I— Grading F-Drainage r Elec r Mech r Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide F_N/A Floor Suite No
scription of Work Use F Const Type
C eVlk1a , 0
# StoriesF # Units (if Res)F_
i— —
Valuation $ o
New/Add SFI Remodel SF 1 ;C ;cl .."} Garage/New/Add Material/Labor`
l
OWNER'S NAME Last I ;� VA-, c�,"
Owner's Address
++
77te,( ,\L
city l.a.��::=A\i.'yV,..�:
First s V\ C, v: , ,
Owner's E-mail Address
State t: Zip cl271 � Telephone
APPLICANT'S NAME Last I First
Applicant's Address Applicant's E-mail Address
City � State Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last M. ,v, -e L First Su ; Lic No. I—
Architect/Designer's Address Architect/Designer's E-mail Address
City I v Cv .,,; ,,\ V. , S1 Qt.y State FT -A Zip CI Z'7G 6_ Telephone
ENGINEER'S NAME Last
First
Lic. No.I—
Engineer's Address
Engineer's E-mail Address
City
State F
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. [--
Class F_
Contractors Address
Contractor's E-mail Address
City �
State F_
Zip F_ Telephoned
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SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. }
PLAN CHECK NO.
PLAN CHECK FEES $