HomeMy WebLinkAboutXR2023-0995 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application QW,r Comm'I r Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r uilding r Grading rDrainage Pt Elec r— Mech
j— Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) f Flood
r Fire r— Liq r Lan ide [_N/A Floor Suite No
1 S ,ry
F_ F—
Description of Work
Use F—Const Type F_
mo l i tVI t-V ("Ve
# Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City F State ( ,
Zip � �� Telephone
APPLICANT'S NAME Last w/ ,Z
First 1 -tL-�
Applicant's Address
Applicant's E-mail Address
�//Z 14yy ,itgi'ird� �C'
� �(� �i I\ �,P) (0M
i v;'SC��`�S4U
City F-/�1' �1�� G1r.S'hG L
Zip � Telephone
ARCH!TECT/DESIGNER'S NAME Last 0 0
First Lic. No. I '
Architect/Designer's Address
Architect/Designer's E-mail dress
City _ 1/1 L,t.�iiijp/l: State I 1 'i✓"Y-
Zip F Telephoned
ENGINEER'S NAME Las[ <� 1 1'-JU�,� First I Lic Noff Q1ty 7
Engineer's Address
Engineer's E-mail Address
I 1 , sT 5,77
City I,% Ul F— State
Zip Telephone 771', Z!�C
CONTRACTOR'S NAME/COMPANY Q
Lic No.
Contractor's Address i.�. �� X,,��ttjonTractors
L�lass�
((
maIAtldress
—'Z7q ° �TL^�°i�� ��S�
S�QsI�-f0) 11rVC) Cal' -
City SC State —
Zip G Telephone q(i1C, TTv5z�7
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x�OT%J ^ �jq
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. '�'GZaT!J--pP7�ia
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $