HomeMy WebLinkAboutXR2024-0033 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
(✓Comm'I ( Kesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
CAuilding r Grading rDrainage r Elec r Mech
r Plum CuYdCut Cuvdriu F
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work �i/ } '¢ AG,
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Use jj Const Type (, —,A
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Valuation $
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New/AddSF� �ea�adelSF / Garage/New/Add I
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Material/Labor /
OWNER'S NAME Last 'T it//-7 4!
First
Owner's Address
Owner's E-mail A
City State F_
Zip F_ Telephone[
APPLICANT'S NAME LastF'112C)r >L
First c %d
Applicant's Address
Applicant's E-mail Address
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City �if1L!'�c /SGri ( ] State f �1
Zip 2 Telephone �/ /
ARCHITECT/DESIGNER'S NAME Last 1 /7/.1?L 7/'/ C
First Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
S/?�E At, /AJ/j7L7L,
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City State ---Zip"��— Telephoned
ENGINEER'S NAME Last
First Lic. No.1�
Engineers Address
Engineer's E-mail Address
City �— State
Zip' Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. [-— ClassF_
Contractor's Address
Contractor's E-mail Address
City State
Zip FJ Telephonel
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �CII Zd —W 33
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK'N`O•.' RMA-005
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $