HomeMy WebLinkAboutXR2025-2345 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
I'r�mm'I esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding F_Gradingr-Drainage j-Elec FMech F- plum Cu Yd Cutler
Cu Yd Fill
r �vjC61; F1QQ ess (Not mailing address) F Flood I- Fire r- Liq r Landslide j-N/A Floor Suite No
of Work ZL S' ,; 22&>V
V/7, Cyr_ l izp.
New/Add SFF�
)Jse �-Const Type (F
# StoriesFV# Units (if Res)
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Valuation $ [%7�
Material/Labor
OWNER'S NAME �+� �----
�L 1�(,L ��%/'/tip �t/� //aI T
Owner's Address / U"�����ll�
/.-.> 71 Owner's E-mail Address
1iev) AL
City / 7,/ /,y State
ZIP _ 7� 1-7 Telephone 7_:�_ 72� i 7C?
APPLICANT'S NAME Last '7JZU A -X First �Y
Applicant's Address
�t Applicant's E-mail Address
CityJN L%591 5L/c rVl�tate ZIPS Telephone a
ARCHITECT/DESIGNER'S NAME
Last TA,,-v /F�L ` First /�
7.4 V4Lic No. -2¢yzc Architect/Designer'sAddre/sus A Architect/Designer's E-mail Address
1 -70 S� Garage/New/Add
City I State
ENGINEER'S NAME Last
Engineer's Address
City State �—
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
x
A�7-z_
TelephoneF
First I Lic. No.F�
Engineer's E-mail Address
Zip Telephone�—
Lic. No. F Class
Contractor's E-mail Address
--
State �— Zip � Telephoner
SETBACKS FRONT
PERMIT NO.
Fj
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $