HomeMy WebLinkAboutXR2023-0997 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Application
o -
City of Newport Beach - Building Division S
Comm', r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding r Grading r`Drainage _ c t)Mech Poilliffirc, CuYdCut cuYdFill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
= A-12G 1i_ FT (
Description of Work Use PEF ConstType \ 1T
#Stories #Units (if Res)
r
Valuation G
New/Add SF Remodel SF :��r \"araLe/New/Add -Q. Material/Labor
bor /
�17 tici f.0
OWNER'S NAME Last
Owner's Address
(� ��L, 7641 PY
City 0 t Q_J Ptr.J r3tfte / State I `--/-
APPLICANT'S NAME Last
Applicant's Address
City � � State I v
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City f q2 l State I
First
Owner's E-mail Address �-7 :-7 �r )
]
t+,(l)lfZ)� � l I A 0 17 `, �At+c'I ((
Zip I (2/�Telephone ��L� ?5- 5-
First I 4- Vl yt
Applicant's E-mail Address
'c�(�
VIVA
5/C�✓I' I(—t���l
Zip % 7 0 Telephone t— Z,c/4 9
Lic. No. G-q7 W
ArchitecUDesigner's E-mail Address
/
Zip Telephone Yv Z3 -+e4 /
ENGINEER'S NAME Last Ulz�e First I Lic No. Q
Engineer's Address Engineer's E-mail Address
1� I ., I�F ]Its
City \U rl F-' /tt �� "yir State 777�_ Zip �Z(QZ � Telephone U 5��o� (�
CONTRACTOR'S NAME/COMPANY Lic. No. `/�Q ✓ 480ass�
Contractor's Address Contractor's E-mail Address
2l0 &1 M 1141
City .i- (i 0- I"�"� ETA State �— Zip yZ,�Q Telephone L�� ` ,4
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
PERMIT NO. AEG (JO
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $