HomeMy WebLinkAboutXR2024-5644 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
[_ Comm'Isidential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G.,..
[_Building [_Grading
[_Drainage ec ,KMech MIum Cu Yd cuts Cu Yd Fill[_
Project Address (Not mailing address) [_ Flood [_ Fire [_ Liq [_ Landslide [_N/A Floor Suite No
Description of Work
Use ConstType s
# StoriesF_ # Units (if Res)F_
�0�, jl for
I;G�,1� r<���Y� 5��,@ �l�r.
Valuation $
Material/Labor
New/Add SFF
Remodel SFF60— Garage/New/Add
OWNER'S NAME
First c re I.,'/kkcj
Last n+.
Owner's Address
Owner's E-mail Address
3�qo _55
yVe
City Y>1 State is w Zip 1 ZQ 2 S Telephone �'/ 'G zf�/- 6173 t;
APPLICANT'S NAME
Last I j ;Lj e First �grU.1�
Applicant's Address
Applicant's E-mail Address
Ic, �vl'..��r
AVM S1t 235 �al,�.�H'i���s�•v_C'_Cr?w.�„'i,Cew
City 110S Y cj
State C- Zip .Z 5� �1 Telephone 7
ARCHITECT/DESIGNER'S NAME Last �f' / {� First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip F-- Telephones
ENGINEER'S NAME
Last j� %� First F Lic No.r
Engineer's Address
Engineer's E-mail Address
City
State F— Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractors Address
Contractor's E-mail Address
City
State F— Zip F— TelephoneF_
SETBACKS REAR
SETBACKS FRONT PERMIT NO. g7-0 S6 4
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $