HomeMy WebLinkAboutXR2023-1092 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F- Comm] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
JXBuilding F_GradingF-Drainage i Elec F-Mech F-PlumCuYdCut r CuYdFill
�
Project Address (Not mailing address) f Flood F- Fire F- Liq F- Landslide F-N/AFloor Suite No
S I� 3C�-Ft^ 5�
F -
Description of Work
Use - Const Type F_
(E) Vo.lcoP,;k(,Ir
o C�.t_jc_ fbb✓i4
# Stories #Units (if Res)
Valuation $
Material/Labor F,1100 O
New/AddSFF— RemodelSFF-
Garage/New/AddF
OWNER'S NAME Last far k5
First
7
Owner's Address
Owner's E-mail Address
Sta 3(,*V\ s4.
City Qo(',� '�e-•S-Cb.� State
ZIP Fq2(o63 Telephone_
APPLICANT'S NAME Last ,t i
First �k f_J l-'t
Applicant's Address
Applicant's E-mail Address
60-ll Vaft`c( Ave—
vv-+ ra 1, Covh
City WDoZ%� !� r (� S State
Zip t (3� Telephone pj ( t
ARCHITECT/DESIGNER'S NAME Last
First F—Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip F Telephonel—
ENGINEER'S NAME Last �
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City � State F_
Zip F_ Telephoned -
CONTRACTOR'S NAME/COMPANY 1 ? /J q j f Q-� L` /1z J S Lic. No. 10 j & S � Iass�
l
Contractor's Address
Contractor's E-mail Address
H 55 5 I-1 ok M ( i V., St
City VaVk 0L jS State C4
Zip LL" TelephoneFt $S t'tC C.
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x A1,151 3-104 2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC2013- 0173
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $