HomeMy WebLinkAboutXR2024-5399 - Permit Application`FormI Worksheet for Combo Building & Solar Permit Application
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_omm'I i X Residential City of Newport Beach - Building Division
\ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage r Elec f— Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
r" Fire r Liq r Landslide f N/A Floor Suite No
�Z C�CrSICCt TV( (2WC) F F
Description of Work
Use 111,:i ff Const T e
Yp 4 I�
4w
# Stories L # Units (if Res)F
Valuation $
Material/Labor
New/Add SFF Remodel SF ,f�f Garage/New/Add F—
t �17
OWNER'S NAME Last GI
First (V-C�Ie
Owner's Address JJ
Owner's E-mail Address
1Lcc l6a C�,s.
Irk�Jvluar�iar I�eC j cuf.�clm
City IvILUr� k ��7 f State CfT
Zip �(Z(zL-0 Telephone 9LjC1
APPLICANT'S NAME Last j ItAC�F k✓j Gl I1
First k( (_C
Applicant's Address
Applicant's E-mail Address
C`
�fi%ti�Ir'C�.y?(�C�yiPY�t'�C ►�`k'd_t_�' �l'i'1.
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City State l
Zip 6. C,, Telephone
1 3 ,
ARCHITECT/DESIGNER'S NAME Last
FirstF_—Lic. No. �—
Architecl/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip �— Telephoned
ENGINEER'S NAME Last
First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip F_ TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic. No. r_— ClassF_
Contractor's Address
Contractor's E-mail Address
City State �—
Zip F_ TelephoneF—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.xR(' 410 S399
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $