HomeMy WebLinkAboutXR2023-1957 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I rxesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
"uilding r Grading rDrainage F_Elec r—Mech
r"Plum cuvdCut CuvdFill
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Project Address (Not mailing address) F_ Flood
i— Fire i— Liq r" Landslide rN/A Floor Suite No
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Y i) Z4 ,� o /C E,I;.Id
Description of Work
Use F—ConstType F
12(A) �/ [1{ U
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1 4/WVO 4/
lid- Q�
# Stories #Units (if Res)
Valuation $
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New/Add SF T Remodel SFI '� Garage/New/Add I lC_/=•-.
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Material/Labor 30/ r1 vV
OWNER'S NAME Last I [ik5[J rJ
First J o Jy
Owner's Address
Owner's E-mail Address
City �✓�?G� r�- L _ State
Zip �G�� (y, 3 Telephone 3/6- W -7
APPLICANT'S NAME Last K°{t. e )/
First I P(}A%
Applicant's Address
Applicant's E-mail Address
City /,'G State 1/4-
Zip Telephone yI' ,yU7 ldvifJ
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip F_ Telephoner
ENGINEER'S NAME Last
First F_ Lic. No.F
Engineer's Address
Engineer's
City _ State F_
Zip F_ Telephoner —
CONTRACTOR'S NAME/COMPANY Lic. No. /Q 13yK Class
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Contractor's Address
Contractor's E-mail Address
�o/ Shy �;�c� `t/t
�/r.� v(' h :1cti (ct i4t
City ��/✓D�1n� �(:lc� State
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Zip GG(ll7 Telephone6�L(l. �5��-1777
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SETBACKS REARSETBACKS FRONT
PERMIT NO. ,iC rJ,�LQTL/
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ! C Z-C, — O
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $