HomeMy WebLinkAboutXR2023-0572 - Permit ApplicationPrint Form- Worksheet for Combo Building & Solar Permit Application
F- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.,. o..
F-Building C Grading F-Drainage [Elec FMech (' Plum Cu yd Cut_ Cu yd Fill F
Project Address (Not mailing address) C Flood F- Fire F- Liq F- Landslide FN/A Floor Suite No
1113 _
I_- F---
Description of Work
Use _ ConstType _
/Ue, ) bloc,/- w jop of
t?w,ci-tvt&1 SI�e-
# Stories # Units (if Res)_
.—
Pe�IN t_ �a -- [a11 re -I! -x !
1
3�oyvca _ ----
_
Valuation $ I Sr
Material/Labor 1
New/Add SFF Remodel SF�
Garage/New/Add L—
OWNER'S NAME Last
First
Owner's Address
----
Owner's E-mail Address
- 11t3 I/_I>nys -
City ;j (1�1 State ( ZIP Telephone�-
APPLICANT'S NAME Last IjUr��'S
First\/
Applicant's Address
Applicant's E-mail Address
PC) —6ox--73Z
City - /v' J - State C (/� --
zip / 2(Pi Telephone7t- q%S- xY3
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. �-
Architect/Designees Address
Architect/Designees E-mail Address
c City State F
Zip F Telephone—
ENGINEER'S NAME Last FA S -rFM L
(
- First PW_ 2 Fplhe� Lic. No. 301� 6`7
Engineer's Address
Engineer's E-mail Address
City State F_
Zip I Telephone�—
CONTRACTOR'S NAME/COMPANY U�LSS t�C Lic. No. qq� Class G8
_-
Contractor's Address
-- - --
2�'
Contractor's E-mail Address S
Q PO_ �0- - 7 3 z - — --
city NY J - State C(/}—
Zip I rq� j f Telephone �1 - g7s—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. \ZZ(TLs7 -
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO;/ - �lq
USE ZONE DEVELOPMENT NO
DEVELOPMENT
PLAN CHECK FEES$9