HomeMy WebLinkAboutXR2023-0103 - Permit ApplicationPrintForm__l Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division a F�. omml �sidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i
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V�Uilding (— Grading j—Drainage r Elec FMach f— Plum CuvdCut F CuYdFill
Project Address (Not mailing address) F Flood F_ Fire r Liq j— Landslide i—N/A Floor Suite No
2 7_325 676 >//9'0/Alrr L71z ln!>/ z
Description of Work A' �12_
Use�ConstType /-
/ v- Ana 124pt-/4�/ri��X
# StoriesRF # Units (if Res)
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New/Add SF�— del SF ?-Z Sj Garage/New/Add �—
Valuation $
Material/LaborZrJ�7, �X
OWNER'S NAME LastFirst
Owner's Address Owner's E-mail Adder
City _ _ - `"State Zip F TelephoneF—
APPLICANT'S NAME Last 7/P-4,',4 X First
Applicant's Address Applicant's E-mail Address
/4 sL?a� Ayy /�i f z 1
( �Uf / PO �G CC71G(
city 14L.�jA SLA4j-,9 State 4 Zi Z Z Telephone p-� P �/ 2�S-sSig
ARCHITECT/DESIGNER'S NAME Lastlr?/S/V/ P/7—/ First I IZAVOY Lic. No. . 2
Architect/Designer's Address
Architect/Designer's E-mailddress
City—3tat€�— Zip Telephoner
ENGINEER'S NAME Last First Lic. No.�—
Engineer's Address Engineer's E-mail Address
City State F_ Zip TelephoneF___—
CONTRACTOR'S NAME/COMPANY Lic.No.� Class 57
6
Contractor's Address Contractor's E-mail Address
City �— State F— Zip Telephoned®
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SETBACKSREAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. LZp D i a 6
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $