HomeMy WebLinkAboutXR2023-0720 - Permit Applicationgr�2oz� --a7zo
Print Form_ Worksheet for Combo Building & Solar Permit Application
C_<omm'I F_t�sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
PKilding F_Grading f—Drainage F_Elec
Description of Worki
New/Add SFF--
%J'eyy/A 6,f /45—12W.A7/49L
[Mech
F Plum
Cu Yd Cut l Cu Yd Fill
Flood
r Fire j.- Liq
r Landslide _N/A
Floor
/ S/,� Garage/New/Add F—
OWNER'S NAME Last/f /���' C!/ First
Owner's Address
Owner's E-mail Ad
City _--� State Zi _ p
Suite No
4
Use 4— 7UConstType
# StoriesR # Units (if Res)
Valuation $
Material/Labor /T1027 of
APPLICANT'S NAME Last /
��LI/�� First V �- `/
Applicant's Address Applicant's E-mail Address
�GI %z G4 AC i7vF !/ �/,f fc zdl d��`id�� Co
City /�� -
<<— �'%� dA /SG AVID State �— _ l
_ /� Zip `�� Z Telephone
ARCHITECT/DESIGNER'S NAME
Last � �/V j f�e j }�� i
lI �L 5
Architect/Designer's Address First Lic. Noll
E-mail Address
Ss-P"t-- a✓�z
city
State ip Telephone
ENGINEER'S NAME Last
First �� Lic. No.
Engineers Address Engineer's E-mail Address
C ity
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
State F ZIP F Telephone[_ —
State F
Lic. No. �l �� ClassF
Contractor's E-mail Address
Zip F Telephoned®
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE nFVFi r)Pry r:K[T kin
PERMIT NO. ' / `
PLAN CHECK NO.