HomeMy WebLinkAboutXR2023-0671 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application
r Comm'] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building [- Grading F-Drainage r Elec [-Meth F- Plum C Ydc F_
- u ut Cu Yd Fill
oject Address (Not mailing address) C Flood F_ Fire r Liq r Landslide _N/A Floor Suite No
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New/Add SF F_
Remodel SFF— Garage/New/Add F__
OWNER'S NAME Last /Cp/,*
Owner's Address
First
Use F ConstTYpe
# Stories # Units (if Res)F—
Valuation $ F9Ot
� .�Material/Labor
Owner's E-mail Address
City ti�� State �— - - -
F ZiP �2(3 j Telephone (J i� )J� 3 - 4-9() 2
APPLICANT'S NAME Last
clkZ First � k
Applicant's Address Applicant's E-mail Address
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City State Zip ,� 12 Telephone �9 CC 77 u
ARCHITEC /DESIGNER'S NAME Last _" _`� � � I
_yG YGiJL - First Mo k&*kK(� Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
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City - ��'✓/%�� _ -- -- State - Zip I J%6l , F��)Telephone
ENGINEER'S NAME
_ yt7�t� c. No.0�
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Last � //L�QP� ..- - -- First Li
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Engineer's Address Engineer's E-mail Address
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State 4A _ zip , yt 2 �_ Telephone �6 _ 73U- i 6S
CONTRACTOR'S NAME/COMPANY Lic. No. 108 q 6� SClass (3
Contractors Address Contractor's E-mail Address
city I -
SETBACKS REAR
SETBACKSLEFT
USE ZONE
State F Zip �— TelephoneFc
SETBACKS FRONT PERMIT NO. kala) / 7 .- D 6-7
SETBACKS RIGHT PLAN CHECK NO. `2 - D S t o
DEVELOPMENT NO
PLAN CHECK FEES $