HomeMy WebLinkAboutXR2023-2684 - Permit Application-ormI Worksheet for Combo Building & Solar Permit Ap
City of Newport Beach - Building Division
r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading j—Drainage r Elec r' Mech
r plum Cu Yd cut[_ Cu Yd Fill F_
Project Address (Not mailing address) I- Flood r Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work S
Use F—Const Type
# StoriesF # Units (if Res)F—
Valuation $
Material/Labor, c
New/Add SF1 Remodel SF� Garage/New/Add �—
OWNER'S NAME Last Vl L nET
First y
Owner's Address
Owner's E-mail Address I
1L-� 0 , I I S Ic,
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CitY lState —riZip
l_ TelephoneI��`t.,),) 7()b s ASS
APPLICANT'S NAME ° i
Last ..,," I-0
First \ p r
`
Applicant's Address
Applicant's E-mail Address
City Gn v ,�7 State r
Zip � Tele hone �M 3 S 3
ARCHITECT/DESIGNER'S NAME Last First I
Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
tn� 5 0.,A-CLS;�k-( - M(,l I W�
City C cam. CJ� State �—
—
Zip Telephone
ENGINEER'S NAME Last I F' /
First / Lic No. `l b (7 p E
Engineer's Address
Engineer's E-mail Address
l^I"4S?-dc_5iyoSCs✓ V)-0•, rG0—
City � � (� �h State Cr✓')—
✓NAME/COMPANY
ZipC�071 1'7- Telephone t,Z ��5 3767
CONTRACTOR'S
Lic.No.
(� P� 7/ro?/ Class
Contractor's Address
Contractor's E-mail Address
City --Fyn—_ ,��Ar�,y` (�� �� State �—
.( �"A
Zip Telephone -735- 3S i N 62b
93 mL o
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $