HomeMy WebLinkAboutXR2023-1713 - Permit Application (2)Print Form
_ Worksheet for Combo Building &Solar Permit Application AGO
F_ Comml j�Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFS M IF AT TIMP: n❑ ci IDRAI=A i
Building F_ Grading F-Drainage XElec VMech rX(PIum Cu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) F7 Flood F_ Fire F7 Liq r- Landslide F_N/A Floor Suite No
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Description of Work A( I � c 22 y Yt
Use �3 Const Type
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# Stories # Units (if Res)7
New/Add SF C
1 , �� r Remodel SF �(� Garage/New/Add • f 7 S
Valuation $
Material/Labor -( o CUB C�
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OWNER'S NAME Last �J9GCNb)ZI First
Owner's Address
Owner's E-mail Address
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t tits rt) P7f }iu 1 State C Zip L%(C._ P
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APPLICANT'S NAME Last n -
t71�l�i.y First �VIl)
Applicant's Address Applicant's E-mail Address
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City l rt�}6 �} (tL� State C/} Zip �z(o,sj� Telephone �f`j - s% 3 �d SZ)
ARCHITECT/DESIGNER'S NAME
Last �lCii�. _ First 'j�}�qp Lic. No. C27 q�; L
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Architect/Designer's Address Architect/Designer's E-mail Address 7
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city State C� Zip gZlosa TelephoneF/ ti572� /OJT --
ENGINEER'S NAME Last /J���oc! First FrAccZ Lic. No. FC37�3
Engineer's Address Engineers E-mail Address
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City Ct4(�(ilVwL) State F_77q_ Zip Telephone N S 7(p -�Z�
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class
Contractor's Address Contractor's E-mail Address
City State `\ Zip� VI.S
�— Telephone Z 1
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS J
LEFT SETBACKS RIGHT PLAN CHECK NO. U
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $