HomeMy WebLinkAboutXR2023-1418 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application °Rr
I- Comm] (- Residential City of Newport Beach - Building Division
NOTE: PLAN CHFCK FFFR nl IF AT TIAAC n� ci iMZ A177ni °
F_BuildingF_ Grading rDrainage r Elec r Mech
F- Plum cuvdCut
F cuvdFill
Project Address (Not mailing address) f- Flood
j- Fire F Liq r Landslide FN/A Floor Suite No
3A8 L u 0Ua
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Description of Work
Use F— Const Type
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# StoriQ_ # Units (if Res)r_
Valuation$��`"
Material/Labor 50111,
New/Add SF�--
Remodel SFr-- Garage/New/Add �-
OWNER'S NAME Last
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First 1 4 1-
Owner's Address
Owner's E-mail Address
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City Daj"4 LIB'
State T ZiP 8yQ Telephoner— Q
APPLICANT'S NAME Last
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First 6r�9
Applicant's Address
Applicant's E-mail Address
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f 6AQr0D1nbti vemk by . L,7,6/V
City ��� ��
State C(T Zip
g D Telephone (�� -S�a3
ARCHITECT/DESIGNER'S NAME
Last q fff prad F-
9 First I N QU Lic No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
/5333 r 57f
Stp.3yZ�
ocd-'�9andoCQs/g�c�aul/oa�.na
City rrv�'
State
Telephone 7a3- 783d
ENGINEER'S NAME Last
First�� Lic. No.
Engineer's Address
Engineer's E-mail Address
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tnm�ba.r,�ese . eom
City /%Jc�� MP��
State F e Zip
9 /_ Telephone 6y� 3
CV CJ—
CONTRACTOR'S NAME/COMPANY
Lic F— No. Class
Contractor's Address
Contractor's E-mail Address
City 4O& M /]Ll%Q ZIP
_
F_Telephone[
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.L2iL3 •'Z9
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $