HomeMy WebLinkAboutXR2023-2423 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 0A,1r r Residential Comm'I City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j'ouilding r Grading j—Drainage r Elec r—Mech r— Plum Cu yd Cut Cu Yd Fill F
Project Address (Not mailing address) r Flood r— Fire r Liq r— Landslide r_N/A Floor Suite No
g
r
Description of Work �-1 4-J-) ✓r 1 Rtw c
Use j Y Z Const Type \ ��
1`\ C Vtfi
ncl .5 ' 1 -L 1.1.i I ✓r
[/� C1 I/ i(J J�C'lc1
# StoriesF # Units (if Res)
nCj
(
Valuation $ lee Q O v
Material/Labor i
New/Add SF�— Remodel SF 3L
Garage/New/Add �—
OWNER'S NAME Last �'ILI
First
Owners Address
Owner's E-mail Address
City\`� L r,.
\_' Yi1'�-�' I �-t_.Gi.[V, State [-_.i,� Zip Z(p(r, C; TelephoneF
I
APPLICANT'S NAME Last r��` 1
First (,
Applicant's Address
Applicant's E-mail Address
City I V[l rN(A C) I t• j State I L I I
Zip l Telephone �% 1 ZZ�!%
ARCHITEEC,T/DESIGNER'S NAME Last I First F_— Lic. No.
dres
Arc itecUDesigner's dA
Architect/Designer's E-mail Address
City State I
Zip F_ TelephoneF__
ENGINEER'S NAME Last Tl_>J c '_�,.
First Lic No.F
1
gineer's Address v WEngineer''+s E-mail Address
�(.�iJ U Cy �, l � �,' � Li V� �-C.P� . [ (�✓t-1
� `'� I �D � — b �L-.
City ] State L. N
Zip C1 Z i_� Zj(� Telephone LJC' Z J (p�
CONTRACTOR'SNAME/COMPANY
Lic. No. Q36%y ClassF
rr//
Contractor's Address
Contractor's E-mail Address
City State
Zip � Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. M?,0203 • M3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. W?A23 -2126
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $