HomeMy WebLinkAboutXR2023-0991 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division g
r Comm'I residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading rDrainage r Elec r Mech
r' Plum Cu yd cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood
I— Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F Const Type
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It Storiesr— #Units (if Res)[_
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Valuation $
Material/Labor *,
New/Add SFr—i Remodel SFr I Garage/New/Add —
OWNER'S NAME Last _f*U j[j30)
First Skp(I
Owner's Address
Owner's E-mail Address
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City K)911 Jf �.,�kCk State F-7—
Zip Telephone
APPLICANT'S NAME Last �>Eldm Agfe—
First SI--EPKCIv
Applicant's Address
Applicant's E-mail Address
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City IZQC c pJ t�f{�j State 79c
Zip 11 % Z"j Telephone CA 13
ARCHITECT/DESIGNER'S NAME Last ri/
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First Lic. No.
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City I State F_
Zip F— Telephoner
ENGINEER'S NAME Last
First F_ Lic. No.r—
Engineer's Address
Engineer's E-mail Address
C5) I r-V-6-
0(,� t3«MF_cc,
City 54Q) - kw)' — State GYM
Telephone 65� -335- � 101
Zip F, 0
CONTRACTOR'S NAME/COMPANY H L_L�yt ��ST L,T'j I NC_ Lic No. Q �Q(3( Z ClassF
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Contractor's Address
Contractor's E-mail Address
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lVi�tUQ'ih�}��LEiL�aW`�TSu ftOj�.Cbl�
City 51 State �
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Zip �� Telephone qI� . -_ -LLo , -{i0
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �( oz 3 — U o 1i ( I
I'} Z
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PCZDZ 3 - oft
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $