HomeMy WebLinkAboutXR2024-5311 - Permit ApplicationPrin,Form Worksheet for Combo Building & Solar Permit Application o4'�"e
r Comm'I Residential City of Newport Beach - Building Division � r
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
t% wilding r Grading rDrainage �Eiec %""
lum Cu vd curl (� —Cu Yd Fill F�--
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Project Address (Not mailing address) F_ Flood
Fire F_ Liq r Landslide I —N/A Floor Suite No
Description of Work
Use (ZT Const Type
# Stories # Units (if Res)
New/Add SF� Remodel SF �-C�� Garage/New/Add
P
Valuation$ w/ti
Material/Labor, /l6
OWNER'S NAME Last xzw'rg POU*4,96�
First t21 e V_\A rL77
Owner's Address LA ��i V I N
Owner's E-mail Address
City I � State 7l7
Zip ji Telephoned
APPLICANT'S NAME Last
First 0/.iZzg�Y
Applicant's Address
Applicant's E-mail Address
�W/,RZ( Vi17--(i—' IL•CCtj
City State Gam -
Zip 92(o r,�5 Telephone go 24b>40?�;
ARCHITECT/DESIGNER'S NAME Last 5Af-I
First Lic No. i9(v37
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip I Telephoned
ENGINEER'S NAME Last
First Lic. No.F—
ti Ow
Engineer's Address
Engineer's E-mail Address
City State F_
Zip Telephoned
CONTRACTOR'S NAME/COMPANY oytiN�rZ �j UI L (J�%� Lic No. F-- ClassF—
Contractor's Address
Contractor's E-mail Address
City State
Zip F_ Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.�2�-+�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $