HomeMy WebLinkAboutXR2023-0571 - Permit ApplicationPrint Form r WPo
_ ___ j Worksheet for Combo Building &Solar Permit Application F R.
F Comm'I f Residential , J�? City of Newport Beach - Building Division it
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Building F_ Grading j-Drainage rElec F_Mech F-plumCu vd Cuts Cu Yd Fills
ProjectAddress(Not mailing address) [ Flood F Fire F_ Liq r- Landslide CN/A Floor Suite No
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Description of Work
CVVlt/l 1,3I,GGIe-- oiz,P, OVlv,- Use Const Type _
Stories # Units (if Res)s
New/Add SFs— Remodel SF F—Valuation $ Garage/New/Add �— Material/Labor
OWNER'S NAME Last I Y iG VA� First
Owners Address -
Owner's E-mail Address
City `V \3 - State CI Zip Telephone Gjc{
APPLICANT'S NAME Last R 1 6 l'l� First
Applicant's Address Applicant's E-mail Address
-8�3-7 7wty
City State �(� Zip �Z6�� Telephone 9(y5-
ARCHITECT/DESIGNER'S NAME Last fi� c W 5 e vt First f �/I L /_G S
-_ - ---�- -- -_ _'�'� Lic. No.
Architect/Designees Address ArchitecttDesigner's E-mail Address
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City " C iiC l �rl Zip - T� Telephone ((
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ENGINEER'S NAME Last First F_ Lic. No.s-
Engineer's Address Engineer's E-mail Address
City s® State �® Zip TelephoneF
CONTRACTOR'S NAME/COMPANY � � L400;�y-7,5CPTe__ Lic.No. H�%&b Class
Contractor's Address Contractor's E-mail Address
City Nj r% 5 State C� Zip 0I (3 TelephoneI
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT �PLAN CHECK NO. //�( ✓v �' V
USE ZONE DEVELOPMENT NO T T �rW215 CU,/ PLAN CHECK FEES $