HomeMy WebLinkAboutXR2024-0776 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application u4�� °�_
r Comm'I (— Residential City of Newport Beach - Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL N,.oa.��
rBuilding r Grading r—Drainage r Elec r Mech
r Plum cuvdCut F CuYdFill s
Project Address (Not mailing address) C Flood
r" Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Uses Const Type
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# Stories # Units (if Res)s
Valuation $
Material/Labor F9,co
New/Add SF7— Remodel SF I��Garage/New/Add F—
OWNER'S NAME Last 4Gvf v b
First
Owner's Address
Owner's E-mail Address
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City MPlU� � l� 6,t State I `- J
Zip Telephone 77 (O✓t'�
APPLICANT'S NAME Last G etA-J First (/Ij
Applicant's Address
Applicant's E-mail Address
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City State
PlUOr1TAE6 I car
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Zip _po Telephone ! 4lL Z04' 01W
ARCHITECT/DESIGNER'S NAME Last
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First (2 r; -�[�! LIC. No. �-
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Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F Telephones
ENGINEER'S NAME Last
First Lic. No.�
Engineer's Address
Engineer's E-mail Address
City State F
Zip F Telephoner
CONTRACTOR'S NAME/COMPANY //// / Lic. No. Class
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Contractor's Address
Contractor's E-mail Address
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CityT State -
zipv Telephone C7 /
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XP ZQZq —
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.jL)
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $