HomeMy WebLinkAboutXR2024-5381 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application DEWPD1m
r Comm'I r Residential City of Newport Beach - Building Division q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I —Building r—Grading F-Drainage rElec rMech
F-plumCuYdCut F cuvdFill
Project Address (Not mailing address) I— Flood r Fire r Liq r Landslide I —N/A Floor Suite No
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Description of Work
Use F—ConstType F_
PRIMAR`i 6SFUVA &Ehr C El
# Stories #Units (if Res)
Valuation $ 3S S 00
Material/Labor
New/Add SF Remodel SF l� d Garage/New/Add �—
OWNER'S NAME Last (CQ sdln f
First S, rj1R-
Owner's Address
Owner's E-mail Address
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City nJ� ar-A `6,rAck State Ft1 —
Zip 9a,U60 Telephone`ly^I_g�S-1,16(�
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City �— State F—
Zip F-- TelephoneF—
ARCHITECT/DESIGNER'S NAME Last First IJor Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
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City 2e�ar can gear State F(
Zip F°102`11 Telephone $l5�-Sd3- 1o6(33
ENGINEER'S NAME Last
First Lic. No.r__
Engineer's Address
Engineer's E-mail Address
City State �—
Zip r— TelephoneF—
CONTRACTOR'S NAME/COMPANY oq 5
Class . o,i s
Contractor's Address
Contractor's E-mail Address � a V I � L,
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City tlWn�c ( ate State �—
Zip �1Gd�� Telephone�I$ SLl-o-o3
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �L)
I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $