HomeMy WebLinkAboutXR2024-6872 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application c6xy pc - ung vision� Comm'I r Residential Citof Newort Beah BildiDi_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r— Grading
r-Drainage r Elec r Mech r Plum cuydCut CuvdFit F
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
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Use fti _� ConstType , ;
K_YR_
# Stories # Units (if Res)F
Valuation
Material/Labor
New/Add SFF_—
RemodelSF1 Garage/New/AddF_
OWNERS NAME
Last First
Owner's Address
Owner's E-mail Address
City [_
State �— Zip [_ TelephoneF_
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City N>", �, " -,`'i. State J Zip v1 L Telephone
ARCHITECT/DESIGNER'S NAME
Last First
RT�, Lic. No. C _ 7T { ,
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �,> ZiP s �2 Telephone 7i� ?',� - nL(-
ENGINEER'S NAME
Last First F— Lic. NoF
Engineer's Address
Engineers E-mail Address
City
State F— Zip F_— TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic. No. ��, ` ^ i� Class /a �,
K I✓ _ I✓ t��f
Contractors Address
Contractors E-mail Address
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t
City n{'�., �. , t-,
_,.� State �; - fi Zip `, 4_ L_ `, Telephone 7,�
SETBACKS REAR
SETBACKS FRONT PERMIT NO. )( Z-Z02 `j
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $