HomeMy WebLinkAboutXR2023-2384 - Permit Application_ Print Form _Worksheet for Combo Building & Solar Permit Application
r Comm'I r- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�IBuilding r Grading ["Drainage AElec FMech JF Plum CuYdCut
I CuYdFillF
Address (Not mailing address) f- Flood r Fire r Liq r Landslide rN/A
Description of Work
New/Add SF V1 Remodel SF
iU 2
Garage/New/Add
Floor Suite No
Use Fw- ConstTypeW
# Stories I # Units (if Res)T
Tiq
�}— Valuation $ , d!
Mor �co
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OWNER'S NAME Last r �G,} r�Cl) First �� �j► �� L1.
Owners Address I Owner's E-mail Address 'r r
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City p�., � State Zip I —I i;i `� Telephon `oQ , ;4r(i
APPLICANT'S NAME Last I P4 -z.;v
Applicant's Address
- 44we/fbtr
City I� State
First I wt�1 At
Applicant's E-mail Address i
I ivrc)eSigh t
Zip ar 7, TelephoneF
ARCHITECT/DESIGNER'S NAME Last Ki 2 First`
G Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
OJT Ujiiireje.St-t1 C 1 v ad •ta4.i -
City �O State F Zip elephone L� -2t,9 .149
14 j
ENGINEER'S NAME Last n [�� J���C 1�1i First _ / /�L✓ic. No. r '�J Q
/ 1
Engineer's Address Engineer's E-mail Address
V►hL��'t r �
City I �� tQ0 State Zip q7Z TelephoneG�
CONTRACTOR'S NAME/COMPANY
T f2 }
1 %Y
Lic No. F—
ClassF_
Contractor's Address
Contractor's E-mail Address
City �—
State F—
Zip F Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
1C-Un_ vof
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
�'rLOi7%'�Qy
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $