HomeMy WebLinkAboutXR2024-5711 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permitjiplication
r Comm'I F-_/Res i d e n ti a I City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
r-Building r Grading r-Drainage FV-tlec rjfech
r�lum CuvdCut F CuvdFill F_
Project Address (Not mailing address) F_ Flood F_ Fire r- Liq (- Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type F
_
GA
11RZVOGIL
L
# StoriesF #Units (if Res)
Fix i orze:s , Pr✓��l( N� (-V—IDOE -
Valuation $ 4 �i.'6lo l � w,
Material/Labor ti: ` rl/l.l. �t
r — �---- g
New/Add SF� Remodel SFI V Z �'1. Gara e/New/Add F—
OWNER'S NAME / In tJ�
Last
l�
First �
I�
Owner's Address
Owner's E-mail Address
NC441 IL11,1G0LN
(L(YL'I( ts(T&MA(L tom
City v1 II r A PAWL State F E;�-
Zip of Telephone 7r�{ �31-g6)It-
I I(�Fi(rsttI
APPLICANT'S NAME Last A��
73E*1�
Applicant's Address
Applicant's E-mail Address
1 lSrj Wt "Vo G i
IZ_Nc_SLNtVi� COIJS iL�►t14� ,c��l
City C IYJP0 S State �—
INL7Last
Zip Cr0j676, Telephone 1Li--31,-k-WI
ARCHITECT/DESIGCNEER'SNAME
� �� First MAW'- F_
1' r`K-f Lic.
Architect/Designer's Address
Architect/Designees E-mail Address
5���-mom . D S
,�QtW
City �1L (�,�7k'l.( State CCA
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[�/ j'/
Zip lC17gC,1 Telephone �Z_��C% "S 1`jty
ENGINEER'S NAME Last
First �— Lic. No.7
Engineer's Address
Engineer's E-mail Address
city State
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class
Contractors Address
Contractor's E-mail Address
City I State �—
Zip F_ Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $