HomeMy WebLinkAboutXR2023-1778 - Permit Applicationr_
Print Form I Worksheet for Combo Building &,Solar Permit Application
r' Comm'I Residential City of Newport Beach - Builoing Division $
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading F-Drainage rElec rMech
rPlum CuYdCut CuYdFill F
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide F_N/A Floor Suite No
Lle FL i A 4' G6/m
F F
Description of Work
Use ConstType
# Stories # Units (if Res
Valuation $
Material/Labor y i� QQQ
New/Add SF� Remodel SFFwq � Garage/New/Add
OWNER'S NAME Last v—o qE—
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First kl -(- W%LF
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last )
First M t Ex//7
Applicant's Address
Applicant's E-mail Address
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MV64FAI_�a_ `C?m,4ic: Qom
City �� " PFL 41144 State [ ZiP ✓l�/��- Telephone �3�(I�— 0?01
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ARCHITECT/DESIGNER'S NAME Last /_ R_5f � �A Lic.
Architect/Designer's Address
Architect/Designees E-mail Address
i �� N'. V✓ I661b- S7-
ik-des yh(20 aL(1caxn
City I ORAN6c State Z;?7,
Zip q J Telephone /4) 70-7613 V
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ENGINEER'S NAME Last i«L 0P 1_r�
First Lic. No. e L ISS
Engineers Address
Engineer's E-mail Address
Win.�/f�
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City �/y��% State
Zip y Telephone
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CONTRACTOR'S NAME/COMPANY
Lic. No. Classi
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F__ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. PUGcri/3 - l5 L 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 'x(ZrLt)Z — t
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $