HomeMy WebLinkAboutXR2023-0128 - Permit ApplicationPrint Form
Fczcomm I F
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[1--'Cuilding F_ Grading F-Drainage F_Elec rMech F= Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) C Flood F_ Fire F_ Liq r- Landslide FN/A Floor Suite No
LfjS5' err) uu- 1. _ 1/N11�5 /hS3lr _+ln52(
Description of Work
Use F_ Const Type F
# Stories #Units (if Res)
De cit KZe7ci r
Valuation
New/Add SF Remodel DP Garage/New/Add �
Material/Labor
�l �(
�SFp
OWNER'S NAME Last (f"!Jr\ _ ��iC-. First pia✓� �i°_,tj0
Owner'sAddress Owner's E-mail Address
//e
7 4 �5{ eA Cen9 4 —v. S OwiGO _lu
I C?
City lit_ I IAJ5 12.4"al State � 0 Zip 76012 Telephone -720, 2613. 12 0
APPLICANT'S NAME t(
Last _ U(N Ge.c.✓_ First /7I,2NHL-�
Applicaant'sss Address Applicant's E-mail Address
— 05-0_��^^�� 2N � _S yt,\ q Ut VJC,YtG.Y &_ Cc C :N-- VgS4-yr- i ov. c
City L4Kl-C(SrY1u�'� State ILi`i ZIpF? Telephoneg5�� 6 y�3
/
ARCHITECT/DESIGNER'S NAME Last �yl�u,rvtacrOY� First CZ�(Z(Zv Lic.No. CIS23y
Architect/Designees Address Mo secr Aye_w f ec�5 Architect/Designer's E-mail Address
251 E. l�,.Q�r�aC 1�ykwal_ ¢t3o 5 encaxnac'�o+� @ uSSex'aycti'r�a-1-s. c
City FV (�P r �r1 State /� Zip I 2835-_ Telephone -71'� , f -4 � 914'�
ENGINEER'S NAME Last First S vca✓e2- Lic.No. 5-5-(2
Engineer's Address L S Engineer's E-mail Address
�OSl1@ d.cge.QgSpc,;c.-�e5 .GGwc
City — State F Zip Telephone 7�ft Y5.A(ot1
CONTRACTOR'S NAME/COMPANY /A� uc.No. g3fB3q Class
rS �. a O11
Contractor's Address Contractor's E-mail Address
�ecoKc_3f
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. XRZOL 3,oO' Z 9
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PCto23- 0133
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
1_.