HomeMy WebLinkAboutXR2023-1641 - Permit ApplicationPrint Form_j Worksheet for Combo Building &Solar Permit Application oF��°°am
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL<��oa."
r—Building rGrading rDrainage r—Elec rMech
rPlum CuvdCut CuYdFill
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Project Address (Not mailing address) r Flood
r— Fire r— Liq r— Landslide rN/A Floor Suite No
Description of Work
Use F—ConstType F_
43 C-�%l� 7 (' llf GIy'S
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# Stories #Units (if Res)
�7�tGE Grs� tri 3 Pj 15ET�1<�' i,�t s ��
Valuation (j s 6 Q
Material/Labor/
New/Add SF� Remodel SFFT Garage/New/Add
OWNER'S NAME Last
First 6hy--7 7) P
Owner's Address
Owner's E-mail Address
z %I S S
4: w,a�rcir -T05?:'41 g gA,\
City V466Je r-7�.-/._ �0 State
Zip Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F—
Zip F_ Telephoned
ARCHITE T/DESIGNER NAME LastFirst I J r kJ Lic. No.
ArchitecUDesigners ddress
Architect/Designer's E-mail Address
519
i I - Gonn
City State
Zip Fz6[9-9 Telephone)¢ 2`72— IF(p7-q:
ENGINEER'S NAME Last I fiE-CIAT
First �''-xv y Lic. No. G •D6&6 97
Engineer's Address
Engineers E-mail Address
IC-1 Q / Z %}% Sf
S tZ 1 � 51 jfs � f;V�J - G br,(N
City State Fai—Dip
Telephone (� Z%Z f � �
CONTRACTOR'S NAME/COMPANY
Lic. No. F—Class
Contractor's Address
Contractor's E-mail Address
City State F—
Zip Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 'X\Z11. (,3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $