HomeMy WebLinkAboutXC2024-0192 - Permit ApplicationPrint Form
F Comm'I r
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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P"B'uilding r Grading
rDrainage r�ec F�Nlech r✓Plum cuvdCut F_ CuYdFill F
Project Address (Not mailing address) r Flood r Fire f Liq r Landslide FN/A Floor Suite No
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Description of Work
Use F ConstType F 'A
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# Stories #Units (if Res)s
P
E
Valuation $ FZ:;�rpw
Material/Labor
New/Add SFF
Remodel SF I Zt 1 Pict- Garage/New/Add
OWNER'S NAME
Last �i CIQr , V! (t y-v yam- (P "L r � First
Owner's Address
Owner's E-mail Address
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City I 'v-V, V"L
State F� Zi it Tele hone
APPLICANT'S NAME
Last t2 A43;L L QA 1N `, ) First I N `V0
Applicant's Address
Applicant's E-mail Address
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City 5 1, VtV t I(\,_
State EA Zip Fi 7 U 17 Telephone I J�- 701 -- C) 5-0-
ARCHITECT/DESIGNER'S NAME Last .Ar" 1� y� First K Lk.- Lic. No. ET (144'
Architect/Designer's Address
Architect/Designer's E-mail Address
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City `Yr v
State Zip Gt 2 Cc 1,7 Telephone y 2 fC I
ENGINEER'S NAME
Last First F Lic. No.s
Engineer's Address
Engineer's E-mail Address
City
State F Zip F— TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. 7U� Class
Contractor's Address
Contractor's E-mail Address
City
State F Zip F Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO. & 2 —(JI rj Z
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $