HomeMy WebLinkAboutXR2023-2535 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading
rDrainage r Elec rMech
j- Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) F_ Flood
r Fire r Liq (— Landslide Rl�/A Floor Suite No
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Description of Work
Use Const Type
`j }
# StoriesF_ # Units (if Res)F—
l01�icu 4 ,
Nb[
Valuation$
Material/Labor '� t—% ` 't- t_•'
New/Add SFF Remodel SF F — Garage/New/Add F
OWNER'S NAME
Last t' ��'� _ -. `—:
``
First
Owner's Address
Owners E-mail Address
City
State
Zip F TelephoneF_
APPLICANT'S NAMEOil
Last
First
Applicant's Address
Applicant's E-mail Address
City
State F_
Zip F— Telephone [ , �. / (� I 11
_
l tt lJ
ARCHITECT/DESIGNER'S NAME Last
FirstF Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F—
Zip F TelephoneF_
ENGINEER'S NAME
Last �`\j, "j�; n_
First J L_�tr, Lic. No..+,+ pia'1'
�F
Engineers Address
Engineer's E-mail Address
City `'`.;�.1 ? ('
State I l '�
Zip ` !i 1 L Telephone %[I.IG` , �- C.k ll_.
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CONTRACTOR'S NAME/COMPANY
Lic. No. I ���j� Class
i_
Contractor's Address
Contractor's E-mail Address
City F
State
Zip TelephoneF
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. LD2t It -III
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.Y4012�?j
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES S
Print Form I Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
f- Comm'I F_ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V
F_Building r Grading r-Drainage r Elec F-Mech
(- Plum CuvdCut F cuvdFili
Project Address (Not mailing address) f Flood
F_ Fire F_Liq F_ Landslide I -N/A Floor Suite No
9
/ / 9 IJ[W,,oI>4 �&r
D,
F__ I
Description of Work
Use F—ConstType
# StoriesF_ It Units (if Res)[ —
LO/1MM. 77
Valuation $
Material/Labor
New/Add SF F_ Remodel SF l Garage/New/Add F_
OWNER'S NAME Last
First
Owners Address
Owner's E-mail Address
City
State F—
Zip F Telephone[ —
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City I
State F_
Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME
Last
First 7— Lic. No. l—
Architect/Designer's Address
Arch ltect/Designer's E-mail Address
City
State F___
Zip �— Telephone[
ENGINEER'S NAME Last
First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
2 C
City
State F—
Zip �— Telephone '- i ?n�i , ; ; -2 ,.
NTRACTOR'S NAME/COMPANY
JTb,D.
Lic. No. Class) 1
Contractor's Address
Contractor's E-mail Address
6 qq I f la f At--,P-.
*)-TrI�
tM;I� L.)-rbu,- e�5 ccvv�
City Wt'5i- H' 15
State k� Y I
Zip q/ 0-7 Telephone <6/�_y,,-3F3 %,
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. Xri 2o'L3 - 02'yi
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $