HomeMy WebLinkAboutXR2023-2586 - Permit Applicationl Print Form I Worksheet for - ao Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r- Grading rDrainage r Elec F_Mech
r' Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood
.r Fire r Liq i- Landslide F_N/A Floor Suite No
Description of Work
Use F Const Type
#Stories #Units (if Res)
(Let, ^,sal%F_t/A/(Z
iserTAaft n ro Y elan w"a.( r AneA)r s2,,=*4AE 7xy
oa
New/Add SF F-d/ Remodel SFJJ�- ;1�y- Garage/New/Add F—
Valuation
Material/Labor
VL--7- t Y
OWNER'S NAME Last 6=tl,,M;LL
FirstI -rfIJA,
Owner's Address
Owner's E-mail Address
100,` f t//A 4A,-4
T1 D>E1�
City r"G6✓ D -T )k,4CA State r C.�
ZipFT 2,7 Telephone (71q
APPLICANT'S NAME Last 7OR�
//��
First /2,C ,Al
ImailAddress
Applicant's Address
Applicant'sE-
1 `%01 � aA-) 4:7-:77. s u (7!�_ / ZO
7,-n(@ C,3 Z/Cf�r NE,7'
City I #.(�/�d�`r 1JGaCx State C,�
Zipl 9Z,4�6d Telephonelgy g'3�s
ARCHITECT/DESIGNER'S NAME Last �-i�T First F,4R/57fAM Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
1`%oi �UAll 5T Sg17?F %Zn
Ro)_VeCJG/GIf%e-IrcT
City State Gas
Zip 91 �6p Telephone
ENGINEER'S NAME Last SrC(4P&4g 3r-(
First s Lic. No. C-677M
Engineer's Address
Engineer's E-mail Address
97S1 aL,-7o-m rP PF-) ,/ ,F-
City Be-,4C4, State C!'t
Zip 72(��j Telephone 7'/y X9i6 -677Z
CONTRACTOR'S NAME/COMPANY A,J p� w, hl G./y� i - co �y Lic No. jj-(vSf$6°r Class
Contractor's Address
Contractor's E-mail Address
fiAJDlLEU,W Fj(G dL KE @ YA+1oo. CDJA
City State F_
Zip F_ Telephone 9yy 683 -Yyyz-
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 4,5-% o
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. epeU j; .
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $