HomeMy WebLinkAboutXR2024-5495 - Permit ApplicationI_ Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I$esidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading j—Drainage r EJec j Mech r Plum Cu vd CutF_ Cu Yd Fill F_
Project Address (Not mailing address) Flood r Fire Liq r Landslide rN/A Floor Suite No
W V
of Work
New/Add SFRemodel Remodel SF
OWNER'S NAME Last
Owner's Address
Use Q�'�Const Type
# Stories # Units (if Res)F_
Valuation $ /�
Garage/New/Add �— Material/Labor
First
Owner's E-mail Address
City State F R Zip FI517M Telephon J1 bZ•
APPLICANT'S NAME Last f C V First
Applicant's Address
Alit q, 0104
City State Zip
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
_ i c> C.
pplicant's E-mail Address
Telephoneiv �•��
First T __ � Lic. No.
Architect/Designer's E-mail Address
City (_ i)„ G+`--ram State Zip I-7_ �. 7,7- _ Telephone
�—
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
First
Engineer's E-mail Address
Lic. No.F
State Zip �— Telephoned
Lic. No. �— Class
Contractor's E-mail Address
State �— Zip Telephoned
ACKS REAR
SETBACKS FRONT
<S LEFT
SETBACKS RIGHT
.aE
DEVELOPMENT NO
PERMIT NO. x)t-"' 2—j S`-+ 1
PLAN CHECK NO.
PLAN CHECK FEES $ _