HomeMy WebLinkAboutXR2024-0103 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application D�)qQ1,P-
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City of Newport Beach - Building Division Comm'IResidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage r Elec rMech r Plum cuvdCut F cuvdFill F
Project Address (Not mailing address) r Flood r Fire r Liq r— Landslide rN/A Floor Suite No
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Description of Work
Use ConstType
# Stories # Units (if Res)
Valuation $ Fq/
New/Add SF Remodel SF I ]3 Garage/New/Add Material/Labor O o O
OWNER'S NAME Lastl , �auh� First KC_J�Y
Owner's Address 1 Owner's E-mail Address
Z Z _ Men-6t,,
City ew� (T � � State C Zip M6 5 4 Telephone F q 933 -12 r( 6
APPLICANT'S NAME Last I VIZ
Applicant's Address
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City rF, �ve-S "de— State CA -
ARCHITECT/DESIGNER'S NAME Last
Architec esigner's Address
City State F
First l 6?_FN10
Applicant's E-mail Address
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Zip (ZS� f _ Telephone 7lILr-80?- ;?r,7-_.
First
Lic. No. I—
Architect/Designer's E-mail Address
Zip TelephoneF
ENGINEER'S Pc VIE Last First F_ .l Lic. No�
Enginee ' Address Engineer's E-mail Address
7ltyF-
State I Zip F— Telephonel—
CONTRACTOR'S NAME/COMPANY S01 iu i o� Coo of+y SCrvlce s Lic. No. 10q 13Y6 Class
Contractor's Address
SWE Iqs IN PLIANT
City State I
Contractor's E-mail Address
Zip F Telephone�—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PLAN CHECK NO. 'Wt,ZOZ, w
PLAN CHECK FEES $