HomeMy WebLinkAboutXR2023-1630 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application of?E"" 0R0
r Comm'I j� Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
ITBuilding r'Grading F-Drainage FElec rMech
r-Plum cuYdcutCuvdFill F
Project Address (Not mailing address) I- Flood
r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use F—ConstType I "_
#Stories #Units (ifRes)7d—
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Valuation $ WV COD
Material/Labor C wV
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New/Add SF 2� Remodel SF `S'D Garage/New/Add �
OWNER'S NAME Last 47k) N'V
First F540N
Owner'sAddress
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Owner's E-mail Address
City N •r' • State I CJ+
Zip TelephoneF�c,j .11,1 )_Z�
APPLICANT'S NAME Last QjA U,
First C _14j " Ll—
Applicant's Address
Applicant's E-mail Address
21_Ic z. PGA 0100
City ur�n dh bW State
Zip q Telephone 94-11•G?7i-7-)605
ARCHITECT/DESIGNER'S NAME Last C:v, First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F— TelephoneF__
ENGINEER'S NAME Last tAl j Lc
'9.J
First 11ni j Lic No. g
Engineer's Address
Engineer's E-mail Address
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City 4UA n� it:Gt �I' 1 State �
Zip q IZ44 Telephone -1l4 • �'L -�
CONTRACTOR'S NAME/COMPANY G n)/ D� i1r..Q
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A j f✓ Lic No. P51Class
iContractors
Contractor's Address
E-mail Address
cki, A — �11�f t, I (A_ .)
City I State
Zip �— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. (W.'fw�ny*Sn'q
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $