HomeMy WebLinkAboutXR2024-5827 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F�mm'I residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(—/Building r Grading [_Drainage r Elec r Mech
(— Plum CuvdCut F CuYdFill
Project Ad ress (Not mailing address) r Flood
r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work 1411-1
q % f
Use s Const Type �.
# Stories # Units (if Res)T
II/,4C&5; / .Vt )
Valuation $ / ��°a•
Material/Labor /
New/Add SF� I �ZG Garage/New/Add
OWNER'S NAME/G/QG �%�L`//�� <faly Awv/
Owner's Address
Owner's E-mail Address
��j % " / Nam"�/
(F'Y(Ile cawip; (J V �, 0-e'l-o
City ��'( /jf' State I"
7r Zip (J/'7 Telephoned-7�Q/ 1�9
APPLICANT'S NAME Last -�//) / �/
First , J Aly
Applicant's Address
Applicant's E-mail Address s
City ry /j �;� /<,' (i4iL-� State A
Zip 1� -�2 Telephone •- �_„�- � S/ t-
ARCHITECT/DESIGNER'S NAME Last /r—;' ft�,! First FTA -G'r' y Lic. N 2 Z2�j
Architect/Designer's Address
Architect/Designer's E-mail Address
----------------
1
City a
p Telephone
ENGINEER'S NAME Last
First Lic. No.�
Engineer's Address
Engineer's E-mail Address
City State F
Zip F— TelephoneF
CONTRACTOR'S NAME/COMPANY
Lic, No. F__ ClassF_
Contractors Address
Contractor's E-mail Address
City State F
Zip F TelephoneF
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XicZ`)4 t{-EF Z.7
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $