HomeMy WebLinkAboutXR2023-1439 - Permit ApplicationPrint farm Worksheet for Combo Building & Solar Permit Application
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Comm'I R Residential City of Newport Beach - Building Division '
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
RBuilding �; Grading
F-•.Drainage ".Elec j- Mach F! Plum CuYdCucF_ CuYdFill r ,
Project Address (Not mailing add ess) i- Flood r Fire f- Liq F- Landslide (-N/A Floor Suite No
fCll N
Description of Work
Use ConstType
# StoriesIT # Units (if Res)[_
Valuation $ S-00
MateriaULabor C
New/Add SFF Remodel SF
Garage/New/Add �-
OWNER'S NAME
Last r,/,jJG� _
First B
O ner's Address
Owner's E-mail Address
City I _. .__.
State—, Zip �i TelephoneFXD—i.,
APPLICANTS NAME
Last MEDINA
_ _ First BEN
Applicant's Address
Applicants E-mail Address
1225 LA BAYA DR
BEN@IPERMITCA.COM
City ESTLAKE VILLAGE
__.
State CA
....__
Zip 91362 _. Telephone 18-735-7876 E
ARCHITECT/DESIGNER'S
T/DESIGNER'S NAME Last
__ _ _
, FirstF
_ _ Lic Na �—
Architect/Designer's Address
Architect/Designer's E-mail Address
C'ty. _
-_ State
Zip Telephone
ENGINEERS NAME
Last— _..
_.._ First— Lk.No.F—
Engineer's Address
Engineer's E-mail Address
City
State CA
Zip 1 Telephone-*
CONTRACTOR'S NAME/COMPANY '
� Lic. No. I1) / L l-rl-_-Y Class
Contractor's Address
Contractor's E-mail Address
City
State
Zip Telephoner
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. x/Q 0,0Z3
SETBACKS LEFT
SETBACKS RIGHT
PLANCHECKNO. f G//riZ�7��1J0
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES S