HomeMy WebLinkAboutXC2023-0172 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application QW0
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
jdBuilding r Grading F Drainage F Elec f- Mech
F- Plum CuYdCut CuYdFill F
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide F_N/A Floor Suite No
F I
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Description of Work
Use F_ Const Type
�Zeplace Ilke frJ� Itke (�� P�ck�U t,�nitS
if StoriesF # Units (if Res)[_
Valuation $
New/AddSFF— Remodel SF Garage/New/Add
Material/Labor 0000
OWNER'SNAME Last Cfcoc
First I �4C%?,l
Owner's Address
Owner's E-mail Address
G 0 0 S4 14nd.. t -
City /V -e C * beC,C k State C 6
Zip ZCp 3 Telephone S�
APPLICANT'S NAME Last
First ,Seen
Applicant's Address
Applicant's E-mail Address
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City 1 f v, p State
Zip �-z G too Telephone `� --iH t') _ 13 Li l
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F__
Zip F_ Telephoned
ENGINEER'S NAME Last l i-n (1 jA t z ,+
1
First Ct 1-e (1 n Lic No.
Engineer's Address
Engineer's E-mail Address
I yco C�ua�� mil- S}-e- a4s
City FNe Q0,4 fJQG•C,h State C�
Zip `lz(P�� Telephone Rv�'1_ -;l-J6 0,L�bg
CONTRACTOR'S NAME/COMPANY SQOn L� tGI�� / MTV Ey-jer� i_ Lic. No. G—(7, 1 Class a/cg0icl
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Contractor's Address
Contractor's E-mail Address
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S e cn - h I cl�f�r L ern cof, n e-i
City � MSC State L�—
Zip °( 7- Telephone `lLi-1-�— i3�1 1
SETBACKS REAR SETBACKS FRONT
PERMIT NO.K(.ty?3 • O17Z
-TBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
ZONE DEVELOPMENT NO
PLAN CHECK FEES S