HomeMy WebLinkAboutXR2023-2495 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I f— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FBuilding rGrading rDrainage FElec r—Mech FPlum Cu Yd CutF Cu Yd FIIII
Project Address (Not mailing address) Flood r Fire F_ Liq Landslide F_N/A Floor Suite No
Description of Work
Use ConstType F
_0 = �� a
# Stories # Units (if Res)F
Valuation $ 1 S 60
Material/Labor 1
New/AddSFF—. Remodel SF�— Garage/New/Add—
OWNER'S NAME Last JA-Dfl- Firstl
Owner's AA ress Owners -mall
City oV � State ( /' n Zip �C� 3 Telephone�� (t,9
�t�
First 4
APPLICANT'S NAME Last! S �k l l 14
Applicant's Address Applicant's E-mail Address
I(�����S��T(a,�Go�r. Ulm
/'/� Zip -T d��0� Telephone �)
City �`�.7'cA State I C� Pr
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
Orty _ _ State �— Zip �— Telephoned--_
ENGINEER'S NAME Last I (j fj First R I A N � Lic No.
Engineer's Address Engineer's E-mail Address
�S�D CL200tLt�iD�1,DW Ca-tL ✓&C�
%0M
City S' ��,� ��,�, State Zip 9 a-? C)S Telephones
NAME/COMPANY Lic. No. 3(� /{��d Class I
CONTRACTOR'S
O%/S i N�5 rC\a
Contractor's Address Contractor's E-mail Address
City SP 1 r U4jrr _ State ��� zip s Telephoner
PERMIT NO.
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO -
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $