HomeMy WebLinkAboutXR2023-2702 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division C
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ts�Building r Grading rDrainage /�Elec F;-Mech
/plum CuYdCut s CuYdFill
Project Address (Not mailing address) r- Flood
r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use s Const Type s
# Stories # Units (if Res)s
A-� I.,
i-,vY, V1
L 1, v7 Lvo -/
Valuation $ 2
Material/Labor
New/Add SF 7 ;; j Remodel SF � s3 Q Garage/New/Add �
OWNER'S NAME Last r'`�1; 11/\
o
First �j' I
Owner's Address
Owner's E-mail Address
('F jlilNiIn.r f,1.1,iIva--rp,Y'v/-I
City State �)��
Zlp ",%�y'� �I TelephoneF�
APPLICANT'S NAME Last
First 1VII
Applicant's Address
Applicant's E-mail Address
City {, t�,!'vy'uV'� �% ;qi State FA
Zip L�� ly"' Telephone Cj 46
ARCH ITECTII/DESIGNER'S NAME Last First
F Lic. No. l �t1 (IifCi
Architect/Designer's Address
Architect/Designer's E-mail Address
City lke/,4✓� State 'ij'
Zip (�'��y��) Telephone �1��-�.��i) la
ENGINEER'S NAME Last ���I) First-'V{ �/� Lic No. Zsb
Engineer's Address
Engineer's E-mail Address
h'iG'(: `•VVl1Q i 4' •91K �.�f7
%417)�`i`1+C C 1': ,L ' , (ti�Im
/
City N'-1�1�.%jtV�a. �iI�Y State (^'�1
l
Zip / I.�r.�.,lr�l,�t Telephone �I!jii'�Uy�Y..� 4t�
CONTRACTOR'S NAME/COMPANY 1 Ct p
t YI
Lir. No. F— Class
Contractors Address
Contractor's E-mail Address
City �i (�V'��Lt/'� ���u) State 7
Zip1.1.i1,r J Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.P� . 2-1pL
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $