HomeMy WebLinkAboutXR2023-0512 - Permit Applicationrr rint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division 3�
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jxuildin9Grading rDrainage F_ Elec F_ Mech
Project Address (Not mailing address) F_ [_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Use Const Type
#Stories # Units (if Res)
rDescription
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Material/Labor W
New/Add F 22 RemodelSF� Garage/New/A 7
OWNER'S NAME Last l�, EMLW(First wj
Owner's Address Owner's E-mail Address
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City State �— Zip Telephone
APPLICANT'S NAME Last—� First �—
Applicants Address _ Applicant's E-mail Address
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City F— State �— Zip r— TelephoneF
ARCHITECT/DESIGNER'S NAME Last 7A��a--- First T Q Lic. No. C22 rp
Architect/Designer's Address Architect/Designer's E-mail Address
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` A' State IZ�-- Zip D, Telephone 7� � -�7�3
City
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ENGINEER'S NAME Last Q ��LFirst F35 Lic No. Q o7
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Engineer's Address r Engineer's E-mail Address
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A) k State C Zip %Q Telephone 7657
City S V l Y V
CONTRACTOR'S NAME/COMPANY ok Lic. No. (ogOjSZ Class
Contractor's Address Contractor's E-mail Address
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City S7:7t^04 �/-N State Gf} Zip lz7DS Telephone 'j(� 35-6
SETBACKS REAR SETBACKS FRONT PERMIT NO. h gW — 051Z
PLAN CHECK NO. 'r6"2 j.-04,0
SETBACKS LEFT SETBACKS RIGHT y cam, _ p�1
' r"�' —i^" l PLAN CHECK FEES $
USE ZONE DEVELOPMENT NO 9 (