HomeMy WebLinkAboutXR2023-2399 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ° c"
F Building r Grading F-Drainage r'Elec rMech Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood (- Fire r- Liq r Landslide FN/A�Fl000rr Suite No
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Description of Work
Use ConstType �—
# Stories[— # Units (if Res)[-
1
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Nam„
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f-C,
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Dlart: �� ,xk
New/Add SFRemodel SF F
Garage/New/Add F—
Valuation $ �
Material/Labor
OWNER'S NAME Last�N ,
First
Owner's Address
Owner's E-mail Address
City F/7c)- u '- �` �;r; L. State � Zip C ZC, C Telephone y�� Y-I f
J
APPLICANT'S NAME Last
First <
Applicant's Address
Applicant's E-mail Address
2 L,. 3
City ,'�L` -�� 1 3�.L.i: c.. State ��
Zip �j Telephone Cf/
/ /
ARCHITECT/DESIGNER'S NAME %
Last �Q��rv\L-C-0 First XVk/vac-C- Lic. No. 2Z,=;j'=(
Architect/Designer's Address
Architect/Designees E-mail Address
F1 L1 ry v\ k t r't' ct ve_
L M n c Sl Ci�1t' } U - `t' A--ku
City � v ` � State
Zip I -7,.r (.> TelephoneFTZ 5 -1v -7- C' R1
ENGINEER'S NAME Last
First F Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F_—
Zip F— Telephone[ —
CONTRACTOR'S NAME/COMPANY cV
Lic. NoT ClassF
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ���� Z?
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N07C2dZ3 • t
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $