HomeMy WebLinkAboutXR2024-7059 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
[- Comm] X Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-'Building [-Grading [—Drainage r—Elec rMech [-Plum Cu vd cut CuydFilll—
Project Address (Not mailing address) [- Flood [- Fire [- Liq [- Landslide [-N/A Floor Suite No
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Description of Work
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New/Add SFF— Remodel SF
OWNER'S NAME Last I Q, Ci 5 S tti1 0. v�
Owner's Address
City �C ;.i ] _ \ \� a State FL
APPLICANT'S NAME
Last I �\), �•. 5 S try cC, V1
Applicant's Address
Use F_ Const Type
# StoriesF # Units (if Res)
Valuation $
Garage/New/Add �— Material/Labor
1-7 U '�' 0 :.1� �L c�C. l' -
City PN ,7, rrt State (-
ARCHITECT/DESIGNER'S NAME Last F_
Architect/Designer's Address
City I State
ENGINEER'S NAME Last
First I S co.- ✓A
Owner's E-mail Address
Zip cat L�
First >[-pa vl
Applicant's E-mail Address
Zip cj LL ci L Telephone 3w -3,,,
First 7— Lic. No. �—
Architect/Designer's E-mail Address
Zip I TelephoneF
First
Engineer's Address Engineer's E-mail Address
City State I Zip [ TelephoneF
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
Lic. No.r— I
Lic. No. I— ClassF_
Contractor's E-mail Address
State F_— Zip �— Telephonel—
SETBACKS REAR
SETBACKS LEFT
USEZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $