HomeMy WebLinkAboutXR2023-1061 - Permit ApplicationPrint For Worksheet for Combo Building & Solar Permit Applicationno"gm-D
i- Comm] F-Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding (- Grading rDrainage I- Elec (-Meth r Plum CuvdCut CuYdFill F
Project Address (Not mailing address) r Flood I- Fire r Liq r Landslide FN/A Floor Suite No
121� 8u St De Qf,VC_
Description of Work
Use F_ Const Type
II
F
\� �j "Cy�Co Cott ru Z)VQ!
h°^i1y
# StoriesF_ # Units (if Res)[ —
Valuation $
Material/Labor r' �
New/Add SF1 Remodel SFF
Garage/New/Add F_
OWNER'S NAME Last
First L r 5 k r e
Owner's Address
Owner's E-mail Address
12- 17 B,y S'lde
City F__NC\,, r�k qzc,A State Cam. Zip — Telephhone %Oi- Zvi -']-?-2
APPLICANT'S NAME Last ,[zz5CV'
First g7
Applicant's Address
Applicant's E-mail Address
l\ 20
a
City V"lwC r nq >]c`Pcy State FC4
Zip 1 o'L`(y Telephone
ARCHITECT/DESIGNER'S NAME ('
Last �Q'ra�o � First E(ey z,y r^ Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
`e- V,,45, ` 1
City ('o/'o.nn State (`�.
Zip °(ZQj(�� TelephoneCLi.C(q)326-&q7
ENGINEER'S NAME Last f\ \k N
First 5'�d,. -T Lic. No. C%S (3 -7
Engineer's Address
Engineer's E-mail Address
City t a rCX[-j?, State
Zip ! JZ J y Telephone_15) g y o - 0000
CONTRACTOR'S NAME/COMPANY J j Lic. No.
�r��3 7S0STI CIa55�
Contractor's Address
Contractor's E-mail Address
1120 �n�HKrti1 �/', rJ�e (�
bra,�7l '�ai52/ e tr2 Cone �a v-i
City IyAcey- ny ().c1 State c�
Zip 1Telephone T� D,
SETBACKS REAR SETBACKS FRONT
/�'
PERMIT NO. Oif - 106'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Zp'1,3 O Sb
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $