HomeMy WebLinkAboutXR2023-1649 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application cmr Comml r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading (-Drainage j_ Elec r Mech
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Project Address (Not mailing address) r Flood j- Fire r Liq i- Landslide rN/A Floor Suite No
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Description of Work
Use � ConstType
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# Stories[— # Units (if Res)_
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New/Add SFF— Remodel SF Garage/New/Add
Valuation
Material/Labor
OWNER'S NAME Last l_ ? L -
First TC,V\
Owner's Address
Owner's E-mail Address
City k ��.ti� State I `
Zip F q '���j Telephoner '3 � 1 - 3p
APPLICANT'S NAME Last LA,�-
First TLC
Applicant's Address
Applicant's E-mail Address
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City State C�—
Zip �U'se%G Telephone 31 Q ., 67 _ 3�56
ARCHITECT/DESIGNER'S NAME Last %� I � ��k �Uy First N G5 WN Lic No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
City Linkn- rV Yt 5A State �_
Zip[ C�G Telephone'lt{
ENGINEER'S NAME Last I tJ`- `s \rt� �
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First I Amr' Lic. No. T-SI
Engineer's Address
Engineer's E-mail Address
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City DGS(JnC-k- ` \ 1`' State —
Zip Cf S 3 Telephone a- U _.-t� (41
CONTRACTOR'S NAME/COMPANY ; N`C 1 1 Q / Lic. No.1 Q 3q 33YClassF
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Contractor's Address
Contracttor/'s E-mail Addr ss�
City
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` i! `. V, State �—
Zip l4 c66 Telephone l/v -- y6 % _ 36 J 4,
SETBACKS REAR SETBACKS FRONT
PERMIT NO. >(OZcj 3 - 1 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $