HomeMy WebLinkAboutXR2023-2903 - Permit Application_ Print Form I Worksheet for Combo Building & Solar Permit Application
F- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DHF AT TIMF nF si IRAAITTAI
F-Building rGrading F-Drainage F-Elec r-Mech
F-Plum Cu Yd Cutl Cu Yd Filll
Project Address (Not mailing address) F_ Flood r Fire r Lid r Landslide F N/A Floor Suite No
Description of Work
Use � ConstType �-
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#Stories #Units (if Res)
Valuation $ F10
GONew/Add
Neu. +,x ® 9 rK 80
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/ s
SF Remodel SF Z OcJ /`[ /A♦lllMaterial/Labor
OWNER'S NAME Last
First it I C j-t A
Owner's Address
Owner's E-mail Address
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City /`J j) isL}{ State CvI
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Zip `f�ZLE; 3 Telephoned
APPLICANT'S NAME Last 3> E 5 41
First I A /,, } L_
Applicant's Address
Applicant's E-mail Address
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CtLL��Cir,S[L._ZiLw_l�u'1 YUA�L C� w
City L , 4-f,,4 I' i4l state ( A
Zip (o 6 3 i Telephone SE: z-5Ir72of,
ARCHITECT/DESIGNER'S NAME Last
First F_
Lic. No. �—
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City �— State A—
Zip �— Telephone[
ENGINEER'S NAME Last 5,4i
First iyivl L- Lic. No. C-24 C 5 3
Engineer's Address
Engineer's E-mail Address
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Zx L(L-S),'2E G> L-
City LA.4'(Ar;,Z,d State I `-T
Zip 1 C,63I Telephone 362---5Ct-
CONTRACTOR'S NAME/COMPANY (
Lic No. F26 S 96 S ClassF A
Contractor's Address
Contractor's E-mail Address
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City /,j?,(r( State
Zip 02.6 E 3 Telephone 549.- C, j 2
CC:' - D
SETBACKS REAR SETBACKS FRONT
PERMIT NO. YR?G-Z 3- M` 3_
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PttlyZ
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $