HomeMy WebLinkAboutXR2025-0380 - Permit ApplicationPrint Form , Worksheet for Combo Building & Solar Permit Application caeg-��,e
j- Comm'l r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r' Grading
j—Drainage r Elec r Mech r Plum CuvdCut l CuYdFill F_
Project Address (Not mailing address) r- Flood r Fire F_ Liq j- Landslide FN/A Floor Suite No
Description of Work
Use F— ConstTypeF_
It StoriesF_ # Units (if Res)F—
Valuation $
Material/Labor
New/AddSF�—
Remodel SF Garage/New/Add —
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State F Zip F TelephoneF—
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City I
State F_ Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. F_
ArchitecVDesigner'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
Engineers E-mail Address
City
State F— Zip F_-- Telephone F_
1-CONTRACTOR'S NAME/COMPANY
(_ 7 i �, Lic No. I 22 7? �/G Class
L�I1JtM (le s -gel) h/ 5 kNC
Contractor's Address
Contractor's E-mail Address
02 e (l tit ,d r{
4 lJ�
City
/y'�/,y 17 ! cD
State �� Zip `� �p % Telephone ��) ) 5� C Y j T
SETBACKS REAR
SETBACKS FRONT PERMITNO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK 1\10.
USE ZONE
_ DEVELOPMENT NO PI AN C..HFCK FFFs cZ