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HomeMy WebLinkAboutXC2024-0033 - Permit Application_ Print Form_ I Worksheet for Combo Building & Solar Permit Application o4�`Wm City of Newport Beach - Building Division F- Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL [—Building r— Grading [-"Drainage [- Elec j—Mech r Plum CuvdCut F_ CuvdFill F_ Project Address ({Not mailing address) I— Flood [- Fire [- Liq [- Landslide [-N/A Floor Suite No AA f Description of Work Use F—Const Type # Stories #Units (if Res) J' I� _� _" I Y64te,✓U Valuation $ Material/Labor 3 New/AddSF� RemodelSF�— Garage/New/Add — OWNER'S NAME Last � f LS First �< Skov, Owner's Address Owner's E-mail Address a96 � 1 ��iJl �WJ � G �ie"IJ �..TI. `�)���OZG� C'� C t'rv1 v �, �. City U �}Y 1 In State Zip F_ TelephoneF— APPLICANT'S NAME Last First Applicant's Address (� Applicant's E-mail Address �-`tJtst Jam. CO,n� City ��1/�✓:I` State �— qIC' C CSii �41 ��.,. Zip Telephon c, ARCHITECT/DESIGNER'S NAME Last �pc�j.� First C-1pthT 1y/, Lic No. �— Architect/Designer's Address Architect/Designer's E-mail Address ��"0 Gvlt;w,h;�✓-'��� �=>.ti� ��.,��ns'i°in-Chun City ���X''Jl c"�'2 State 74 Zip �5 - �- Tele hon LJCJ )27�"7 —. -" ,' I r �� P J�J ENGINEER'S NAME Last �— First Lic. No.F— Engineer's Address Engineer's E-mail Address city State F— Zip �— Telephone CONTRACTOR'S NAME/COMPANY Lic No. CI �� IOt/1 v 1��1,'} l inl� ��l�jt'1 � IL(C-6), ClassFCH� Contractor's Address Contractor'sE-mail Address 1' �/ `-�� �IU 6d��,C,\ V'` __ �^'i"/t_ W �'-(,�1:;1]I`I ✓� LCi;'1� city City 'll.�{� State Cam- Zip Telephon C(�C'1 / W� `l SETBACKS REAR SETBACKS FRONT) PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. � - O I $ USE ZONE DEVELOPMENT NO PLAN CHECK FEES $