HomeMy WebLinkAboutXR2024-5772 - Permit ApplicationPrint Form 1 Worksheet for Combo Building & Solar Permit Application aComm'I KResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing r Floold
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Description of Work
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# Stories # Units (if Res)s-
Valuation $ e-•�
Material/Labor
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OWNER'S NAME Last First ,_�l e_ n d
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Owner's Address
Owner's E-mail Address
City State
Zip b 6 D Telephone
APPLICANT'S NAME Last ��v I p
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
First C
Lic. No. �&61 6
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State �—
Zip [_ Telephones
ENGINEER'S NAME Last in )ey
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First [ Lic. No. L%_6 ((�
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Engineer's�Address
Engineer's E-mail Address
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City a,)Ci GL, State Z,�
Zip �07iD Telephoner
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CONTRACTOR'S NAME/COMPANY �� t� l
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Lic. No. 7y5 G')e1 Class
Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. xK. Z Oz t{ — S% 7 Z .
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $