HomeMy WebLinkAboutXC2024-0167 - Permit Applicationp Print Form Worksheet for Combo Building & Solar Permit Application E-Rr
Comm'I ❑ Residential City of Newport Beach - Building Division �)
NOTE: PLAN CHECK FEES DUE AT TIME of SI IRMITTAI
Building ❑Grading ❑Drainage (ylElec Y-A4ech Plum CuvdcutEA CuYdFill
Project Address (Not malting address) E!! Flood Fj Fire j j Liq [ Lanllldslide F N/A FLLLIoor Suite No
Description of Work Use fr��ttvonstType! ��
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I # Stories # Units (if Res)e{
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Valuation r ` !
New/Add SF�—, Remodel SF �j(/ )j Garage/New/Add � Material/Labor
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OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
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City�/� Slate C Zip y Telephone
APPLICANT'S NAME Last First
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Applicant's Address Applicant's E-mail Address
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City �c�f },i State -LC Zip -2,i rl �I Telephone
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ARCHITECT/DESIGNER'S NAME Last ��/� (%f.,.17 First FF/k 11 U1 i Lic No. GAG X,S�i
Architect/Designer's Address Architect/Designer's E-mail Address
City tJW �'�� ���"- State _L%' I Zip G'Z�. Telephone
ENGINEER'S NAME Last First Lic- No.�—'_
Engineers Address Engineer's E-mail Address
City State I Zip ! Telephone
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CONTRACTOR'S NAMECOMPANY Lic No. I Class -
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Contractor's Address Contractors E-mail Address
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. �`�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. G � k
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $