HomeMy WebLinkAboutXR2025-2017 - Permit Applicationl D > /-\ V,�—\0cc.) k- s - Print Form Worksheet for Combo Building & Solar Permit Application F�`WPo"
Comm'I FL Kesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES rn IE AT TIRAP r)P qi IQUITTAI
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Project Address (Not mailing address) r Flood F_ Fire r- Liq r" Landslide rN/A Floor Suite No
A�o'.fir ADP. 117.b�777c �o
Description of Work A/C /2 V Cif +'y77CN
UsConstType
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# Storiesry # Units (if Res)��
Valuation $
Material/Labor
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New/Add SF -Remodel SF c
% �j= Garage/New/Add �—
OWNER'S NAME s ✓1Yc'= ��7 4 �1J C
Owner's Address
Owner's E-mail Address
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City /� G; :�;_ State F77A
Zip Telephone 9� � �%� — Gj 4• j
APPLICANT'S NAME Last A First FDAI
Applicant's Address Applicant's E-mail Address
A 61
- U zt Cl CO J27
City L U A I CA Zip FZ_6�z Telephone
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ARCHITECT/DESIGNER'S NAME
Last A+V' i First lz- ,-u a y Lic. No — 2 _Z
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Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— elephone�—
ENGINEER'S NAME Last First �— Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F— Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No, F— ClassF_
Contractors Address Contractor's E-mail Address
City State F Zip �— TelephoneF_
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO - PLAN CHECK FFFR t