HomeMy WebLinkAboutXR2024-0621 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application rEW�R.
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rrl-(fomm'I r[,Xesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r,,I�uilding r- Grading F-Drainage r Elec r Mech
r- Plum CuvdCut CuYdFill F
Project Address (Not mailing address) i- Flood
r Fire r- Liq r- Landslide FN/A Floor Suite No
x Z 4 f-,,v
Description of Work 7i' i' IA.; °s%fix'
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Use�UConstType
# Stories? # Units (if Res
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Valuation $
Material/Labor /( (/•
New/Add SFF _ •2� c f Garage/New/Add
OWNER'S NAME/CAL
Owners Address
Owners E-mail Address
?�/ `T/� illy y
AVM' e'S & /,/— e e 61 ~1Vo7 �/� r c 61rt17
City / ��%/ /U State C.,r'
Zip Z,/% Telephone % - 72(j
APPLICANT'S NAME Last f j�'� Ls A X
First -.)A y
Applicant's Address
Applicant's E-mail Address
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city State r7�—
Zip ZLG Z Telephone
ARCHITECT/DESIGNER'S NAME NeXT� 7_�i>��—
Last .t1lL!/ �7z_ j First I /� �''v � t/ Lic. N"
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
TelephoneF
ENGINEER'S NAME Last
First Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F_— ClassF_
Contractor's Address
Contractor's E-mail Address
City � State I
Zip F__ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x� (�Z1 �Q 6 =•,1
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �Q
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $