HomeMy WebLinkAboutXC2023-0026 - Permit ApplicationA, �
Print Form Worksheet for Combo Building & Solar. Permit Application ��`'�a>,
Comm][ Residential City of Newport Beach - Building Division 1 tY�^
y NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
JBuilding ❑ Grading [Drainage �_Elec j , Mech APlum Cu Yd Cut cued Fill
Project Address (Not mailing address) [] Flood F] Fire G Liq Ej Landslide J❑N/A Floor Suite No
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Description of Work Use nstT e
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- # Stories # Units (if Res)C
Valuation $
New/Add SF� Remodel SF 3# ++ !/Garage/New/Add Material/Labor —
OWNER'S NAME Last ri �r )N� L��t'' First I,
Owner's Address Owner's E-mail Address
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City State zip Telephone
APPLICANT'S NAME Last I `I% - FirstE'--� --_-
Applicant's Address Applicant's E-mail Address
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City - C� r' f A%f..- State Zip r 'Z.j� phoneJ�'
ARCHITECT/DESIGNER'S NAME Last FN First P� Lic.No.
ArchitectlDesigner's Address ArchitectlDesigners E-mail Address
j ll3� i State F77 Zip r 7-6 -� Telephone
City f% j_ Et 6'i� I�f 1
ENGINEER'S NAME Last First[ Lic.No.[�
Engineer's Address Engineer's E-mail Address
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City �— - _ State Zip—� Telephone
CONTRACTOR'S NAME/COMPANY �j (7j ` E. .r(n/� _ Lic.No. "636 S� Class
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Contractor's Address ontractorsE-mail Address
�3D/ lam/✓E S'T, 11'///T�"_/36 — � N� li r�'i-L(F IGT-US�—. GO1�
city I 1V&A/P&e-7- g:-;iC,q State C{� ! zip 9Z66p Telephone 6
SETBACKS REAR SETBACKS FRONT PERMIT NO. Y4Zc)7_,3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I?C Z2�gL — O
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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