HomeMy WebLinkAboutXR2024-0001 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar hermit Application
Ft,,6mm'I Residential City of Newport Beach - Building Division i=
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL'
�ilding F' Grading
F-Drainage F Elec F_ Mech f Plum cuvdCut F cuvdFill F
Project Address (Not mailing address) [_ Flood r Fire F_ Liq F Landslide FN/A Floor Suite No
Description of Work
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Use ConstType (/
# Storiesr`%/ #Units (if Res)�Z
Valuation
Material/Labor
New/Add SF F
RjrC Y1T
$euredel SF (Ibe >f% Garage/New/Add
OWNER'S NAME
Last C ,�7 First
/
Owner's Address
Owner's -mail A
City �"��
State �— Zip' Telephone
APPLICANT'S NAME
Last -'v, First '�, A
Applicant's Address
Applicant's E-mail Address
City ��y)Ay'/1,� State Zip Telephone
ARCHITECTIDESIGNER'S NAME Last jPA/U,,J,/c j First �L Lic. N -- j
Architect/Designer's Address
Architect/Designer's E-m it Address
City
State Zip TelephoneF�
ENGINEER'S NAME
Last First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State Zip �� Telephone��
CONTRACTOR'S NAME/COMPANY
Lic No. F-- ClassF—
Contractor's Address
Contractor's E-mail Address
City
State I� Zip f •�� Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. XRz it� OW
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. �(—O00'
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $