HomeMy WebLinkAboutXR2024-0097 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j-Building F- Grading j-Drainage F_Elec (-Mech
r Plum Cu Yd Cut Cu Yd Pill F
Project Address (Not mailing address) 7 Flood
r Fire Liq I Landslide I N/A Floor Suite No
Description of Work
Use F_ Const Type �-
# Stories � # Units (if Res)F Valuation $
Material/WborlWooD
% Cat
New/Add SF RemodelSF' Garage/New/Addy
OWNER'S NAME Last �(% N � � 1 �A ILL
First JV
Owners Address
Owners E-mail Address
8 G�c�taw, �L LJ
I
City e. 1 State /'n
Zip- Telephone; S�—`_u
APPLICANTS NAME Last', SM,T��
First!yV�Us
Applicant's Address
Applicant's E-mail Address
C�, S (rt t—% (�- �� State ; /' (\
Cyr i
Zip �� �t �� Telephone I���g 119 /
d
ARCHITECT/DESIGNER'S NAME Last
First'— Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City State �—
Zip Telephoned'--
ENGINEER'S NAME Last �'(I�
First (� ( Lic. No.jgq
Engineers Address
Engineers E-mail Address
�pV 4- 45'
City State C /1 _
Zip � rf OS`�Telephone 1 SI
CONTRACTOR'S NAME/COMPANY Lic No. 6�'](.t.(0 Classr j
Contractors Address
Contractors E-mail Address
113—�r 2_
State
City I JJ� l i� 1 G�� I
Telephone
Zip 19j(F �31i
1.I 0 5 -7 9
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X
O.
PLAN CHECK Nlid
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK FEES $