HomeMy WebLinkAboutXC2024-0328 - Permit Application__ Print Form I Worksheet for Combo Building & Solar Permit Application F_Coni r Residential City of Newport Beach - Building Division (INP
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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r Plum Cu vd Curl Cu vd Fill F_
Project Address (Not mailing address) F_ Flood
T— Fire r- Liq r Landslide rN/A Floor Suite No
Description of Work
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Use Const Type
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Stories #Units (ifRes)F_
Valuation a PTjGG d
Material/Labor
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New/Add SFF Remodel SF� Garage/New/Add �—
OWNER'S NAME Last A r J PS First �0&
Owner's Address
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Owner's E-mail Address
10
City � l ivrjr—r tiw {{ State F?�
Zip Telephone -?I
APPLICANT'S NAME Last f J(Q}Z �li First �I l
Applicant's AddressY�
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Applicant's E-mail Address
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City 51\�f�� ��tl �" State 7l y
Zlp .L 0/ Telephone �`4!
ARCHITECT/DESIGNER'S NAME Last d�� First' V my)tzJ Lic. No. �i,r17/I
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Architect/Designer's Address
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Arch itecUDesigneerr's���E-mail Address
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City N JVgf Mr PA State I v�{
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Zip' %� Telephone � � _V f
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ENGINEER'S NAME Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City State Fi
Zip r Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. ��55OI Class
Contractor's Address
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Contractor's E-mail Address
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City �k State ✓+ \
Zip Telephone 7Pt o I7
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.��
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USEZONE DEVELOPMENT NO
PLAN CHECK FEES$