HomeMy WebLinkAboutXR2025-0119 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (UP
City of Newport Beach - Building Division Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading r-Drainage r Elec r-Mech r Plum Cu Yd Cut G> Cu Yd Fill FT,
Project Address (Not mailing address) F_ Flood r Fire F- Liq r Landslide rN/A Floor Suite No
Description of Work to +'L
Use ConstTypeF
# StoriesF_ # Units (if Res)F-
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New/Add SFF Remodel SFF--4ffi Garage/New/Add
Valuation $ e v
Material/Labor'—
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City Fza p n/.� . c (: G'1 �` State G'4 Zip /� Telephone
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APPLICANT'S NAME Last First 131LL_-
Applicant's Address Applicant's E-mail Address
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City I [_,�' it': } � c.� _,�)� /` State �i Zip ;Z�jl.'rj� Telephone %7 L T17 7o v6
ARCHITECT/DESIGNER'S NAME Lastj C_ 455,IZ -�J T/`� First ( Lic No. - /77��
Architect/Designer's Address `/ Architect/Designer's E-mail Address
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City d/L (7` State Zip �1� Telephone r/ y-/,-24i ` JO g�
ENGINEER'S NAME Last First F_ Lic. No.F—
Engineer's Address Engineer's E-mail Address
State F Zip F_ Telephoned
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CONTRACTOR'S NAME/COMPANY f �0't L- CD ivS Lic. No. ? jg� Class
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Contractor's Address Contractor's E-mail Address �3
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City S a L. L- / i t t State �1+ Zip 1 6, 2, Telephone / ,/ 7
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SETBACKS REAR SETBACKS FRONT PERMIT NO. CwQ" T
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $