HomeMy WebLinkAboutXR2024-5450 - Permit ApplicationPrint Form
Comm'I r
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading rDrainage rElec rMech rPlum CuvdCut F CuvdFill F
Project Address (Not mailing
address) r Flood r Firer Liq r Landslide rN/A Floor Suite No
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Description of Work
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Use F_ ConstType
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# StoriesT # Units (if Res)F_
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Valuation $ GG
Material/Labor /f; Z- 0 J
New/Add SF� Remodel SF fr Garage/New/Add �—
OWNER'S NAME Last
First il// A
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Owner's Address
Owner's E-mail Address
State Zip C/Z g6
11 (� Telephone
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. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip F Telephonel—
ENGINEER'S NAME Last
First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State �— Zip F Telephone�—
CONTRACTOR'S NAME/COMPANY
Dlt� s Lic. No. ��(S�3Q Class
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Contractor's Address
Contractor's E-mail Address
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city �03/A GS C'
State I 7 " Zip ?- Z �- Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. SY
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $