HomeMy WebLinkAboutXR2024-5848 - Permit Applicationit Form JWorksheet for Combo Building & Solar Permit Application zEwP-0.
Comm'I jytiesidential City of Newport Beach -Building Division
//11 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building j- Grading
r"Drainage r Elec F_Mech
F Plum CuYdCut F_ CuvdFill s
Project Address (Not mailing address) r Flood
I— Fire f Liq r Landslide F_N/A Floor No
l
Suite
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Description of War
Use s— Const Type s—
/
# Stories # Units (if Res)F
Valuation $
Material/Labor
New/Add SF Remodel SF �
— Garage/New/Add �—
OWNER'S NAME
,, y,I
Last �C� / f//��
First ` dl /fi/G(
Owner's Address
Owner's E-mail Address
City ap � , l7 State I [ E
Zip Q Telephone z
APPLICANT'S NAME
Last
J
First
Applicant's Address
Applicant's E-mail Address
City I
State F—
Zip F— TelephoneF—
ARCH ITECT/DESIGNER'S NAME Last
First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip F_— TelephoneF_
ENGINEER'S NAME
Last
First F Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State I —Zip
r TelephoneF
CONTRACTOR'S NAME/COMPANY
Lic. No. F— Class
Contractors Address
Contractor's E-mail Address
City I
State F_
Zip Telephoned!
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. XjZ2oZL4 — S cBLJ
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $