HomeMy WebLinkAboutXR2024-6696 - Permit Application7 Ao
Print Form Worksheet for Combo Building & Solar Permit Application � 0
j— Comml r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u°<�o.r.
/f—Building j—Grading r—Drainage rElec r—Mech
,j—Plum cu yd cut Cu Yd Fill
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Project Address (Not mailing address) f Flood
r Fire r— Liq r L e I_N/A Floor Suite No
F
Description of Work
Use F—ConstType F_
# StoriP.# Units (if Res)F
Eu,w,
C.ylili;eL;}c�
Valuation $
Material/Labor —
New/Add SF�— Remodel SF 1 �• 7 i .c\F� Garage/New/Add �—
Z�JF
Iry
OWNER'S NAME Last
First S�JeWM
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Owner's Address {� `1vti^
Owner's E-mail Address
G L SSc��
Cc\�,r\
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City ���� V�/ i CG�tS�r' State C
Zip TelephoneF 1i� = _l L+ . I Z
APPLICANT'S NAME Last ' 1 n
'i'-1%,�,•''� i t
First FTf-tip, � i C'
Applicant's Address
Applicant's E-mail Address
.r
'U `e`.
„y State r
?_(�lCitY
Zip Tele hone
ARCHITECT/DESIGNER'S NAME Last First F_ �—
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip �— TelephoneF—
ENGINEER'S NAME Last
First F— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State F_
Zip Telephoned
CONTRACTOR'S NAMElCOMPANY ,, . , r - Lic. No. Class
Contractors Address
Contractor's E-mail Address
City SlC\V\\ll\ c�`�` State L�fi
Zipl Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. /\� Zx Z-� �1i0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $