HomeMy WebLinkAboutXR2024-0404 - Permit Applicationf Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I (-i~ <esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project A dress (Not mailing address) [_ Flood J_ Fire r Liq F_ Landslide F_ N/A Suite No
�Floor
E F
Description of Work17�' Y/!J �p.�,
Use -2w ConstType V_IX
# StoriesUnits (if Res)17
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Valuation $ 0 C-,
Material/Labor ?�z GG!/•
New/Add SFF I SF S/,�- Garage/New/Add ��
OWNER'S NAME Last /� /� %lit First
Owners Address Owner's E-mail Addre
Cit State Zip F Telephoned
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
/4 6 A l ennV 4 U
City oA c (xxl_�) State — Zip Telephone
ARCHITECT/DESIGNER'S NAME Last I 12—ANI OX4 First 104t/,/JV I-C. N . 2 2ZS
Architect/Designer's Address Architect/Designer's E-mail Address
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City State ip Telephonel
ENGINEER'S NAME Last First Lic. No.s
Engineer's Address Engineer's E-mail Address
City State F Zip s�V Telephoned+
CONTRACTOR'S NAME/COMPANY Lic.No. s� Class
Contractor's Address Contractor's E-mail Address
City � � State F_ Zip I Telephoned
SETBACKS SETBACKS FRONT PERMIT NO. Z02 l -OgOi
REAR
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Pad �b3?jy
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $