HomeMy WebLinkAboutXR2025-0142 - Permit ApplicationPrint Form W,o
l Worksheet for Combo Bung &Solar Permit pplication R,
r- Comm] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES nuF AT Ti n❑ ai iannirr
(-Building r-Grading (Drainage r-Elec r-Mech (-Plum Cu Yd C.tF Cu Yd Fill
Project Address (Not mailing address) I- Flood F_ Fire r Uq r- Landslide rN/A Floor Suite No
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Description of Work e QmS I rew llosw PALdIL
Use - ConstType
on a 1oc del cl dew Ina �nel ors
# StoriesF # Units (if Res)F—
Valuatio4de
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New/AddSF�Remodel SF�— Garage/New/AddF—
OWNER'S NAME Last D%�a) Qnd_1��uST�4Er Fa)�)'IJFirst
Owner's Address wner's E-mail Address
310 _te(_nm& um 1 10
City Nye, � State c(A . Zip Telephone
P 1 �c b 111_�131 _ y l
APPLICANT'S NAME Last IFirst
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Applicant's Address
Applicant's E-mail Address
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City State I Cq— Zip Telephone C�51 -57�%
ARCHITECT/QIGNE NAME Last (` First bf F
u � Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City Ora , State �— Zip W YI 1 Telephone[��(OZ ��t1-12-12
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ENGINEER'S NAME Last First Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State �— Zip Telephone
CONTRACTOR'S NAME/COMPANY /„ 1_ f� i_ Lic. No. F— ClassF_
(,Contractor's
Contractor's Address E-mail Address
City State �— Zip— Telephone-71q -(j3)- %/ 1
SETBACKS REAR SETBACKS FRONT PERMIT NO. X z,-,Z,� —0 He -
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $