HomeMy WebLinkAboutXR2023-0616 - Permit ApplicationPint Form Worksheet for Combo Building & Solar Permit Application oF'`�PoRe
r Comm'I Ik Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building [Grading F—Drainage [Elec F_Mech F—Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) [ Flood F_ Fire I— Liq F Landslide FN/A Floor Suite No
02 Pdw4 Co�nr--i- /Uew�u.r� Coo,.-i -_! p�2,tl)
Description of Work
Use F ConstTypes—
LL--.
e,MI �' �n etS h i
,h 4-1 001n 2 CJ 7 x j
# Stories # Units (if Res)
Valuation $
Material/Labor O Qoo• Cn
New/AddSFF7777 Remodel SF /.2QQ Garage/New/Add —
OWNER'S NAME Last /SL,bC.,4p, First
Owner's Address Owner's E-mail Address
;2 pojka covrh ram, —
City P.t✓ PDo [moo ct_ — [%Q 6 rj State C � Zip Telephones —
APPLICANT'S NAME Last /V e „,„ i First I Cjo,.e_d
Applicant's Address Applicant's E-mail Address
�6611 /I�Arco+ce t ��ji or^nia q� I. cow,
City I %yi55t on V; y a State C /-? Zip q eq Telephone 9GFq, 30�j _ 3t 3�
ARCHITECT/DESIGNER'S NAME Last I"Ou+r-\ First %Ge e ! I1 Lic. No. —i
Architect/Designer's Address ArchitecUDesigner's E-mail Address
2go61 0 ,es o, Pk
_ - -- -— -
_
City 7yy tico CVn State L� Zip IFT267g' Telephone q'4g q a I T71O6
17
ENGINEER'S NAME Last First F® Lic. No.F
Engineer's Address Engineer's E-mail Address
City State �® Zip F_— Telephone[ —
CONTRACTOR'S NAME/COMPANY Co b( prh,� Lic. No. lO�� po8 Class
Contractor's Address Contractor's E-mail Address
266/l /Uaeco� 01
City7°S S ip h uj , o State C � Zip 92 Tele hone
SETBACKS REAR SETBACKS FRONT PERMIT NO. A ,�Z�Z3-(�tfllCo
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.T Pi0V!5 -0 V
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $