HomeMy WebLinkAboutXR2024-1244 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application my t5" Rrm
�7�omm'I esldential City of Newport Beach - Building Division A
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c „,.
uilding I- Grading [-Drainage r Elec r Mech r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work , .,A rev
Use L G• Const Type
# Stories✓ w/ # Units (if Res)��
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Valuation $ /q///��/
Material/Labor j��'/ '-l.(.� -r4
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New/AddSF�— ,__g el5F %�Z Sf Garage/New/Add
OWNER'S NAME %C AC �%G'j/(/Yr Ct �7n LV • Firsts/t7 iz i,�i� lJz�/ZLli�i /�/ems.
Owner's Address O/wner's E-mail Address
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City /1k j1j.i State j! Zip 7W Telephone %y�- 72e
APPLICANT'S NAME Last 7_�e f1 X First ,I/
Applicant's Address Applicant's E-mail Address
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City 13.4 L /� l � y' L1 A s LA1"9 State Zip / Z e Telephonf - ZG ' ,/jam T/
ARCHITECT/DESIGNER'S NAME P r^---
Last �A4-/ F1` / First Z�1 �(JYD1 Lic. No. � is
Architect/Designer's Address Architect/Designer's E-mail Address
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City ��— to Zip / Telephoned_
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ENGINEER'S NAME Last First �— Lic. No.1—
Engineer's Address Engineer's E-mail Address
City State F— Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY I frC-Z �Lic. No. Fo6e71S Class ,)
Contractor's Address Contractor's E-mail Address
City I X0. 1y I,C State l /q Zip q 2 C Telephone '- �'Si vy
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $