HomeMy WebLinkAboutXC2024-0166 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o Etr'°
�C Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .awe'
rBuilding r Grading rDrainage F-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
/0 6 W to i' i64 t a�± � ea ch
CW ` Z4 `0 F s e- �-
Description of Work
Use F—Const Type F
# Stories #Units (if Res) F
off CA,
w
-ec �;
Valuation
G
New/Add SF F Remodel SF Y✓ 49 Garage/New/Add
Material/Laa bor
OWNER'S NAME Last I #Q.,1AW1 t7 j I4Ae f
First & J�Vr. - 6/d/0s
Owner's Address
Owners E-mail Addres/s-"
100 1/101 yy/o
City �caCh State CA
Zip 7 Z 6G b Telephone UGC ,q5 ?_ {mQ
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City I State F_
Zip I Telephone
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City State F_
Zip F_ Telephoned
ENGINEER'S NAME Last
First F__ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F —Telephoned_
CONTRACTOR'S NAME/COMPANY D C �P Al I 'SGI tOh trot . Lic. No. �p� 53Q Class
J �Li A�
Contractors Address
Contractor's E-mail Address
U 31 ifJ�,l r�,u, A--
City G,S� Iq� State Lk
Zip YZL Z7 TelephoneF�'�-�<{�_tf5y�
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. f4®'o
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $