HomeMy WebLinkAboutXC2023-0502 - Permit ApplicationPrint Form
4Comm'I r
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
Building r- Grading j--Drainage (�(Elec (j1C1Vtech
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K.Plum cuydcut F_ CUYdFill
Project Address (Not mailing address) F_ Flood r Fire j- Liq r Landslide rN/A Floor Suite No
4343 /r)cAr /1r4hiAr- 2,ctAjevarrx
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Description of Work
Use 7' Const Type V -
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(in .n
# Staries� #Units (if Res)
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(P1rre��P s- Cie �aA7,, nZW )441ez wsorWjie_ ./FC"14lz_o-{k/:4/r o�;Cd.
Valuation $
Material/Labor 1r407001:)
New/Add SFF_ Remodel SF it P 211 Garage/New/Add �—
OWNER'S NAME Last Snu�cactl cif J rv1_V De,<6(fa^jPrst
Owner's Address
Owner's E-mail Address
City Fi-ir)rlt.Z State 67�41
Zip ?2612 Telephone�� 7%
APPLICANT'S NAME Last jxq
First -� it �i r
f'
Applicant's Address
Applicant's E-mail Address
1�t.1Jf�( e Ctl, Jl�, �lu4s 1fe r; �f-
di A)JjPKtaJ-arrP)If-ctj o.41
City State �—
Zip �— Telephone�—
ARCHITECT/DESIGNER'S NAME Last �ii% First try A r y Lic. No. C - l/O�}' 2
Architect/Designer's Address
Architect/Designees E-mail Address
6ntnt;io de, C—Are e r &0;t , ^yell? 3n..ry OD Kai
City I Car;J+CrrY10 6,1,44,A State /r
Zip�Telephoned . 33�-:12�g-0
ENGINEER'S NAME Last ��,�� � �'j�
First ' S.F {_ yy,7y Lic. No. S 46 J+
Engineer's Address
Engineer's E-mail Address
6461 ISGet� ,0
�truc?u�r=rl,c;�.r,
City 6r,)G2, of � t State o�
ZiP gX6,3o Telephone rj hq3 ��� _ 34go
CONTRACTOR'S NAME/COMPANY I :DC,,?I T Lic. No. �%GI `� %,�i_ Class
CM,Y ,�fttCt(�l1 1 n�
Contractors Address
Contractor's E-mail Address`
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City I 1 state
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zip �� J Telephone %/ in LJ//�j
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. n t/ I(V
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK INOICAMM
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $