HomeMy WebLinkAboutXR2025-0728 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application E.w,e
(— Comm'I �Resldential City of Newport Beach - Building Division G A�e�lf 4'
,, `` NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI '
wilding r— Grading r-Drainage (_ __I-_IOIe'ch r Plum cuvdCut CuvdFiil
Project Address (Not mailing address) F_ Flood r Fire r— Liq f Landslide f N/A Floor Suite No
40 C&I-M�C�1
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Description of Work
Use Const Type F
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# Storie'` / #Units Git }R ' ,
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Valuation
Material/Labor jq_-,3
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New/Add SFF0_ _ Remod
F � � Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
E-mail Address
City
IrO�w—neerr's
State �� Zip r— TelephoneF—
APPLICANT'S NAME Last SAMCE First �LrK�M1�
Applicant's Address
Applicant's E-mail Address
i yo (Ar-M RA#+T Cix ( �
City NEwrig $EA(11A
State F—e.—V Zip qZ6&0 Telephone4 461 36(63
ARCHITECT/DESIGNER'S NAME
Last �W First F_ I �.
Lic. No.
Arch itecUDesigner's Address
Architect/Designer's E-mail Address
City I
State Zip F— Telephone
ENGINEER'S NAME Last
First F Lic No.F
Engineer's Address
Engineer's E-mail Address
City �.
State Zip Telephoned
CONTRACTOR'S NAME/COMPANY
fIvE PlAMilrD5 $UILvINd Lic.No. 167Q, Class
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Alr9 "'i*1F
Contractor's Address
Contractor's E-mail Address
113 W fAiQWA%k
MA1JnQ SE_SS FFDSF (,r►aIL. GeM
city I AtjA q E 1 M
State I WT Zip 412 gos TelephoneFa
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK 110.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES S