HomeMy WebLinkAboutXR2023-2014 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application 04.Etr�
r Comn- 1 j7 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Building j- Grading (-Drainage r Elec r Mech
r Plum CuYdCut CurdFill
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide FN/A Floor Suite No
F— F_
180� a-e(i'%(. (and-
Description of Work
Use F—Const Type I—
C krm IK owl Z Doo c S cK rQ ptiC (A,,I, docj Li 14 Li
# StoriesF # Units (if Res)F
C� e,,5 6"d(,,`I. �cA/a Le /Zoo
-T rtroIJe 7PO
o,-j
Valuation $
New/Add SF F_ Remodel SFF— Garage/New/Add F_
Material/Labor
OWNER'S NAME Last �c(nrea
!)t 1/Cls 5 First
Owner's Address
Owners E-mail Address
I Sofia &tt
Sty/fcr duo/S � �rnaiL. rpm
City !( 3 State 6a
Zi Tele hone
P SzbGo P 7/K-G73- q(ooS
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
i %O t?o �h I l r,..—L
�le,kTC � 11dwp f5 a- 6 m c L i fe �
City go State C4
Zip T 2.lGa Telephone
ARCHITECT/DESIGNER'S NAME Last yCl c)h i First (1 uC 4 Lic. No.
/
Architect/Designer's Address
Architect/Designees E-mail Address
d tz _P, 1 (l1a(�n� s t�
`� i-en�jineec5 0 live 9 com
City �(r;,� � State (rti
Zip Telephone
ENGINEER'S NAME Last 145�i
First ChkylL Lic.No.r
Engineer's Address
Engineer's E-mail Address
A.S A 60—e
City p��,,._State e,L
Zip F gt(� TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic. No. F_Class F
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X bzt_
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. wo"CL 7y "1q
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S iZZ ZOLI