HomeMy WebLinkAboutXR2024-5165 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r�Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not
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Description of Work
New/Add SF�_
OWNER'S NAME
Owner's Address
r-Drainage r- Elec
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j—N/A Floor
Suite No
Use Const Type �—
# StoriesFT # Units (if Res)F—
RemodelSFF Garage/New/Add 9-- — IMatValuaterialon$ /Labor
Last
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Owner's E-mail Address
State 7' —
APPLICANT'S NAME Last
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Applicant's Address
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City I N F2? ,
State
ARCHITECT/DESIGNER'S NAME
Last--
ArchitecUDesigner's Address
City
State
ZiP 9 y fv 2,j TelephoneF —
First) (5Aa- f
Applicant's E-mail Address
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zip2- Telephone '� 49 , y *, - 0 85-
Lic. No. G-19`��
Architect/Designer's E-mail Address
Zip F TelephoneF—
First
ENGINEER'S NAME Last
First �— Lic. Engineer's Address
Address
Engineer's E-mail Address
City State--
Zip F— TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic. No. F� Class
F
Contractor sAddress
Contractor's E-mail Address
City I State r--Zip r� --
Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. J, SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $