HomeMy WebLinkAboutXR2023-3386 - Permit ApplicationPrint Form I Work§heet for Combo Building & Solar hermit Application
(- Comm] (- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading rDrainage rElec F_Mech
[7<Plum CuYdCut CuYdFill
Project Address (Not mailing address) I— Flood
r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
UseUse F—ConstType F_
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# Stories #Units (if Res)
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Valuation $ / O J D
Material/Labor
New/Add SF (c Remodel SF Jyyo/Mo Garage/New/Add ✓�
OWNER'S NAME Last / fl or/gi
First
Owner's Address PCd I ��/' L /
Owner's E-mail Address
9 / 5 Ray
City I P,�, �C6tGIn State
Zip cy )�&(pd Telephone---
APPLICANT'S NAME Last l 0ef
First
Applicant's Address
Applicant's E-mail Address
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sl.� aA40f an tiw
City S", (aCt-, State r ��-
Zip 9j o(()) Telephone kf - 9 70 IF y Jr
ARCHITECT/DESIGNER'S NAME Last
First Ii Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City � State �-
Zip I— Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.r
Engineer's Address
Engineer's E-mail Address
City State �-
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY / / , P n, y L S'C�2_ �� Lic No. 1(C `J L/j ClassF
(n + "�
Contractor's Address
J
Contractor's E-mail Address
t?/7 S. t�sso� � 1� i(p,
S1� 3,y r,M /�Snn�1, �
City /La State 64
Zip -:2, J Telephone -7/y- 9,0 3 zzf�
SETBACKS REAR SETBACKS FRONT
PERMIT NO.%(tnZOC3 JJ 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PCZ023•
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $