HomeMy WebLinkAboutXR2023-1139 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�W�ra
F_ Comm'I r Residential City of Newport Beach - Building Division c s
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c"
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Building [Grading L Drainage f-Elec [Meth Plum CuvdCutF CuydFill
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Project Address (Not mailing address) C Flood j- Fire F_ Liq Landslide CN/A Floor Suite No
Descriptionof Work Use ConstT e
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# Stories # Units (if Res)F
Valuation $
New/AddSFF--Remodel SFF Garage/New/Add — Material/Labor d Cl'Kj w
OWNER'S NAME Last �jg�� J.049S AW
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Owners Address Owner's E-mail Address
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City a�� ( State C Zipj Telephone -I(�ZO
APPLICANT'S NAME Last I 1�J-
�Il.� First �lUI(7
Applicant's Address Applicant's E-mail Address
City -G - (yLS State Zip- ?zZ ssJ Telephone--?Wq_ 573- lash
ARCHITECT/DESIGNER'S NAME Last T����
il( First titNlJ Lic. No.
Architect/Designer's Address Arc
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ct/Designer's E-mail Address
City -C[Lf W ._. VJ ----- - State F6747 - Zip .. �s.3 Telephone qq? - 573- 160
ENGINEER'S NAME Last First F77777 Lic. No.
Engineers Address Engineer's E-mail Address
City State Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. gt 58
7Z Class ry
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Contractor's Address Contractor's E-mail Address
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City Co 53r-C^ McSq State ca Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. x�73 �✓ A3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $