HomeMy WebLinkAboutXR2023-3344 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application^r
City of New ort Beach - Building Division m
r Comm'I F_ Residential Y p g
NOTE: PLAN CHECK FEES DUE AT TIME of sl IRnniTTAI @apem
r Building r Grading
F-Drainage F_ Elec F Mech (— Plum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) F_ F_ Fire F_ Liq j— Landslide rN/A Floor Suite No
Description of Work
Use Const Type
ivP�
D01Ao XtS1� �L
5y(\ - �t
��. �t=5 9cT,,
# StoriesFT # Units (if Res)[,
Valuation $ j
Material/Labor 1�t OJT
New/Add SF��
Remodel SFF— Garage/New/Add �—
OWNER'S NAME
Last \- p_n_') V First (Z�t 55
Owner's Address
Owner's E-mail Address
City Gr 4t-va AtCj,C1
State Fc�—Zip 1Ziu21 TelephoneFtt_�
APPLICANT'S NAME
Last ti L- First
Applicant's Address
Applicant's E-mail Address
City - S,h �
State F�—_ Zip y`2:t-VC;1 Telephone (j, 4q - 3--}- - y ti 3 i-
ARCHITECT/DESIGNER'S NAME
Last First ��^�,
1 � �'fJ� �?_; LtL- Lic. No. F_—
Architect/Designer's Address
Architect/Designer's E-mail Address
City F
State F— Zip �i Telephone
ENGINEER'S NAME
Last First F_ Lic No.F_
Engineer's Address
Engineer's E-mail Address
City �—
State �— Zip Telephone
CONTRACTOR'S NAME/COMPANY �r ` Lic No. t j i j 0 Class
fnruas �.Sn2u�Fl�y
Contractor's Address
Contractor's E-mail Address
SA, --A C, ry� i Cam^ 4/4
City ��--�
State F Zip F_ Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 'RC i2�%2� , 52,Ll
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $