HomeMy WebLinkAboutXR2024-5066 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4m
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G.,.oa '
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Description of Work
Use s ConstType
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Material/Labor
OWNER'S NAME Last r'hyrt�� yt
First ,ti,
Owners Address
Owner's E-mail Address
City ' "��rL State I `^'
ZipF Telephone
APPLICANT'S NAME Last �
First
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last Z� First Lt Lit. No. �—
Architect/DesigneCs Address
Architect/Designer's E-mail Address
City �rdV� �\ V q \c.Y State C4
Zip OiWz, Telephone GN•11-ZOS - 5-75
ENGINEER'S NAME Last First�yr Lic. No.
Engineers Address
Engineer's E-mail Address
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City Nq 4�Nr` ova State G(�
Zip Telephone S�3_b-?-) -bS,>S
CONTRACTOR'S NAME/COMPANY tS � 5«fr. / ��` Lic. No. q1 _zI SL1 Class J3
Contractor's Address/
Contractors E-mail
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Zip Cj2b Zr Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Xi2 to I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $