HomeMy WebLinkAboutXR2024-6926 - Permit Application_Print Form Worksheet for Combo Building & Solar Permit Application ocEWPo„ @
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building (—Grading rDrainage rElec rMech F-Plum cuYdCut F cuYdFill
Project Address (Not mailing address) I— Flood r— Fire r Liq r Landslide N/A Floor Suite No
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Description of Work
Use ConstType I �/
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1 i 0 A V U OWd
# Stories # Units (if Res)
Valuation �/�
Material/Labor[ q/
New/Add SF� Remodel SF S& Garage/New/Add �—
OWNER'S NAME Last Penner First ` e/
Owner's Address Owner's E-mail Address
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City n/O
GY{ /h & State �— Zip 9 Tel neF
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APPLICAN,T'SCNAME Last 10VO / First ���• �
Applicant's Address Applicant's E-m' Address
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City /r�J� State
I Zip � / Telephone �f% �% 3x2)
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip �— Telephone�—
ENGINEER'S NAME Last C �1 /yFirst ' / Lic. No.F
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Engineer's Address Engineer's E��,m��'a��'il///kkkAJJ(//ss
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City ! f� State %� Zip F-Z/ Telephoned
CONTRACTOR'S NAME/COMPANY I ) t_!q/ U&ic.No.v`gli/.2c CClasssJ
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Contractor's Address Contractor's E-mail Address
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City ��Sj� �PC� State t47 Zip 1c�/7 F a�ATelephone tr7 32 f�Z�
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $