HomeMy WebLinkAboutXR2023-1864 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application
r Comm'I rXResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
fZ,Building r Grading (—Drainage r Elec r Mech Plum Cu vd cut Cu vd Fill
Project Address (Not mailing address) I— Flood r Fire r Liq r Landslide r_N/A Floor Suite No
;23e> LILLr: LIJ -f IJf,L)Pe, dr
&,/4cAt CA, 12663
Description of Work
Use F— ConstType
izt �f r I<.- � s,(rate
# Stories #Units (if Res) F
l2 X� 15
Valuation
Material/Labor
New/AddSFF-- Remodel SFF—
Garage/New/Add—
OWNER'S NAME Last PKTLI
First I T_( 'A/A-
Owners Address
Owners E-mail Address
�3z- LI ILL Y LIJ
i1A1/AC P1 i£I C1A -tn � U•,n
City N 2�j PL�P-T /; EACAa State �— Zip Cj Le- E,j Telephone[
APPLICANT'S NAME Last /ts�,4�
First S4, � J
Applicant's Address
Applicant's E-mail Address
City N ^js;o-.% t%j'f C State I "
Zip /L6j Telephone VT/-,///,?_
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. F—
Architect/Designers Address
Architect/Designees E-mail Address
City State �—
Zip F Telephone
ENGINEER'S NAME Last �—
First F— Lic. No.r—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY R I / �� �� Lic No. jyi`3Ik ClassF?
Contractor's Address
Contractors E-mail Address
z,53z k►-k�bA b�
City State ICA
Zip �j y �, j� Telephone /fZ_
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $