HomeMy WebLinkAboutXR2024-0364 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application O` EW GOy6
V�,i`omm'I residential City of Newport Beach - Building Division � )
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I•'tsuilding r Grading j—Drainage r Elec r Mech
r Plum CuYdCut F_ CuvdFill F_
Project Address (Not mauling address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
;�r
Description of Work jC 7f � ✓�nttr+/t�¢
f y[r4rj674/
Use*7�71,� ConstType
# Stories # Units (if Res)[
/
�j
/,�� Ax �� l� _ �/L�J j � � ApaQ
Valuation $Z�l
Material/Labor
cz ZZO N
New/Add SF� fiawgdel SF 5r Garage/New/Add r —
OWNER'S NAME La4//�P`,/w�
Co First
Owner's Address
Owner's E-mail Address___--''—`�
City State
Zip Telephoned
APPLICANT'S NAME Last
First J,q v
Applicant's Address
Applicant's E-mail Address
"k �lz_
t/� •fC'Aewe _(�' [ dG : rd AYr
City /JAGS 01 /QC,A—�� Stater
Zip e1,�yZ Telephone � "-- ��t--
ARCHITECT/DESIGNER'S NAME Last ���j//�
First /A t/Lic. N r!'f'ZZ,5_
Architect/Designer's Address
Architect/Designer's E-mail Address
�
City 1
—
Zip TelephonenL
ENGINEER'S NAME Last �—
First F_ Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City State I----
Zip F_ TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic No. �— Classr�
Contractor's Address
Contractor's E-mail Address
City State
Zip I Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ���✓��- 036
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $