HomeMy WebLinkAboutXR2023-2221 - Permit Application (3)'Tint Form Worksheet for Combo Building & Solar Permit Appli tion
Comm'I r Residential City of Newport Beach - Building Division h
NOTEPI AN r.HFCK PFFC rMI1C AT 7If..1C 11 o
F Building r- Grading
FDrainage r Elec r Mech I— Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r— Fire r Liq r- Landslide F_N/A Floor Suite Nc
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Description of Work
Use FW ConstType
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# Stories5F # Units (if Res)F—
)1��,�t;
Valuation $
Mated on 2 S IJJ
New/Add SFA15�—
Remodel SF ��— Garage/New/Add �—
OWNER'S NAME
Last ��� .�-� First
Owners Address
Owner's E-mail Address
City i wI ) k
State Fcf� Zip 7 3) Telephone
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APPLICANT'S NAME
Last j�ytG-LJ' -�— First ay
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Applicant's Address
Applicant's E-mail Address
012 9 7- ,god
City�
�N� -1- �,ljl
Zi i� Tele hone ^� ['!
State i/� __ p L `�6�� p 114
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ARCHITECT/DESIGNERS NAME Last First I — LjC. No. F_
ArchitectlDesigner's Address
Arch itect/Designer's E-mail Address
City
State F_ Zip [_ Telephoner�
ENGINEER'S NAME
Last First F_Lic. No.F_—
Engineers Address
Engineer's E-mail Address
City
State F— Zip �— Telephone
CONTRACTOR'S NAME/COMPANY
4I1ctisn CSt i/1E S X is Lic, No. F�(j133Class�—
Contractor's Address
Contractor's E-mail Address
6 C 6
City
U MA YV Imo' ICE ow I I C,
State �/ n Zip ( Telephone 7
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SETBACKS REAR SETBACKS FRONT PERMIT NO. XQ1(4" Rx)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �i.2019i ,' yfi
USE ZONE _ DEVELOPMENT NO OI 111 1I .-1 ____ ,.