HomeMy WebLinkAboutXR2025-0057 - Permit ApplicationPrint Form I Worksheet for Gumbo Building & Solar Permit Application
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) f— Flood r Fire r Liq j— Landslide f N/A Floor Suite No
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Description of Work 2 T O
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Valuation
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New/Add SF I "fU Remodel SF 0— Garage/New/Add �—
Material/Labor
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OWNER'S NAME Last First #�
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last 'i2r,L �
First
Applicant's Address
Applicant's E-mail Address
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City State
Zip I Ct-7 _j— Telephone 9gs_S73 /CS'r;
ARCHITECT/DESIGNER'S NAME Last CA S First 'ktC Lic.No. CZy jqb
Architect/Designer's Address
Architect/Designer's E-mail Address
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City (,c�S tjm� E: o State C14
Zip ! 2 Telephone �Gt 'C% %S �y7s
ENGINEER'S NAME Last / ITT
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First R�� Lic.No• GjsCs1/S
Engineer's Address
Engineer's E-mail Address
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City ltvl State CA
Zip Telephone `7/4 _,3,3g - iD (0
CONTRACTOR'S NAME/COMPANY
Lic. No. f Class r—
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Xt W ZS- 0050
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $