HomeMy WebLinkAboutXR2023-1399 - Permit ApplicationPrint Form
{ Worksheet for Combo Building &Solar Permit Application eg
F— Comm'I FKResidential City of Newport Beach - Building Division
NOTE: PLAN CHFCK FFFR ni ir= AT Tenn❑ nD ci 1DnniTTA1 V\�_
r Building F- Grading F-Drainage
r Elec F- Mech
(- Plum Cucvd cut Cu vd rill
Project Address (Not mailing address) F Flood
Fire r Liq r Landslide F N/A Floor Suite No
200/ CA- Lk rco
0V Loro✓!or c(2L
/L/W F F_
Description of Work
Use F_ Const Type F_
f�re
# Stories[ # Units (if Res)
Valuation $
Material/Labor Fir00 d
New/Add SF �— Remodel SF�— Garage/New/Add �—
OWNER'S NAME Last
(it/GOcY%tul/
First AaJ>1.n
Owner's Address
Owner's E-mail Address
ZOO/1
U/ C k� Sq,S[a
17Y
City Cora H ZIC Aicy
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State (I /� - Zi P C(%,6ZS TelephoneF_
APPLICANT'S NAME Last
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First 36 sG r<;,+
Applicant's Address^
Applicant's E-mail Address
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City �1 State �—
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Zip
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ARCHITECT/DESIGNER'S NAME
Last R �( f
�li p First yvUn 64WS Lic No. (o26y2$
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
2372 ,/L(orare /Aae
SIAlf- (i 66
City I If Vtr a
State 11 /4 Zip tiZ� (y Telephonl - 331- $ 9 y3
ENGINEER'S NAME Last
First [_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State [_ZIP
[_ TelephoneF_
CONTRACTOR'S NAME/COMPANY
S Lic. No. (gZg Class
[ VApZ6
uoSu'�-
Contractor's Address
Contractor's E-mail Address
H S( F• /a-�«ms,Y4
City a F /i An R
State 1( Zip
'73 T lephone (, Gz 3'� 3Z`r
q
L
1 l
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. l�''%.(iZ2 , 13rl61
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $