HomeMy WebLinkAboutXC2023-0062 - Permit ApplicationI Print Form J Worksheet for Combo Building &Solar Perm"
J ation ®revw"O,(Comm'I r Residential City of Newport Beach - Building Divisiovvvv NOTE: PLAN CHECK FEES DUE A TIME OF SU ITTA Building F_ Grading rDanageec Mech j�—
\\ lum Cu Yd Cutl Cu Yd Fill F
Project Address (Not mailing address) [ Flood f Fire [- Liq [-Landslide [N/A
Floor Suite No
--
Description of Work 1 �'y Q�}h
Use ConstTvP e
;�-3
# Stories # Units (if Res)F_
New/Add SF 'if Remodel SF Valuation a
-__ - Garage/New/Ad Material/Labor
OWNER'S NAME Last Lh �SJ't�
V � 110Se L.Li. First
- --
Owner's Address - - -
L-L7 N� a(af t Owner's E-mail Address
City — —._
GA
�e 1 State --
Zip ° L6bo Telephone j 14 61 $ �0 3Cl
APPLICANT'S NAME Last Fi�\ L_
_ First
Applicant's Address - -
Applicant's E-mail Address
City - -
State �— Zip Telephone-
---...._ --
ARCHITECT/DESIGNER'S NAME
Last 5-y YY m l }r y �6 5�b; cFirst _ I ji1 � Y�
-- - Lic. No.
Architect/Designer's Address -
Architect/Designer's E-m i Address
City -----
State dip Telephone
ENGINEER'S NAME Last
� First Lic. No.
Engineer's Address Engineer's E-mail Address
City State ®
Zip �— Telephoned—_
CONTRACTOR'S NAME/COMPANY Lic. No. P
_ t �2t11 c6 55 1 Class a
Contractor's Address Contractor's E-mail Address
--
_
City � State PP
v� Zip c�L I Q 5 Telephone -i 1<4 , Cb i , 0`4 7
L
KS REAR SETBACKS FRONTPERMIT NO.KS LEFT SETBACKS RIGHT PLANCHECKNO.
E DEVELOPMENT NO
PLAN CHECK FEES $