HomeMy WebLinkAboutXR2023-1713 - Permit ApplicationPrint Form
(— Comm'I
j Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
OTE, PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building 7 Grading Qv —Drainage VElec WMech Plum Cu Yd Cut Cu Yd Fill
Project Address (NO g address) 1- Flood Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work UZ}i f li t(Z )qW tFij j 7D 1 X�� c-k' 2 �,
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Valuation a
Material/Labor
New/Add SF Remodel SF �— 7
Garage/New/Add 5
OWNER'S NAME Last C l (Fit JZj First �j,& ---�f i �_ 11dZ
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last FP, LL y First OpvtG)
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Applicant's Address Applicant's E-mail Address
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City ({ti' j1A [il vim} State Ci? ZI 7 -
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ARCHITECT/DESIGNER'S NAME Last 5I L Gam/ First 1�p9Ui I� Lic. No. Ez--776,
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Architect/Designer's Address Architect/Designees E-mail Address
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ENGINEER'S NAME Last Itl SCf�I First jC. C5, Lic.No. C N3 Js3
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY 5A &X Lic.No. F474 Class r�
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
Print Form I Worksheet for Combo Building & SolarPermitApplication V rEW�Ra
Comm'I r Residential
Y Pog Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j (Building r Grading rDrainage VElec F_ Mech
1Project
Plum Cu Yd Cut Cu Yd Fill F_
Address (Not mailing address) F_ Flood
r Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use Y' �('.-� ConstType
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# Stories #Units (if Res) F
Valuation
Material/Labor
New/Add SF � Remodel SF �YGara e/New/Add
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OWNER'S NAME Last I (,)I IC U-COI—
First s"
Owner's Address
Owner's E-mail Address_`'`'
70a C iaA I-�i
City N ,N C4 State CA
Zip (7(p(,rG Telephone
APPLICANT'S NAME Last}((.L1/
First I)t}UlO
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last c First _I
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City L+-`LJVf OL,.j State C`f}
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ENGINEER'S NAME Last
First F— Lic, No.F_
Engineer's Address
Engineer's E-mail Address
City I State [_
Zip F_ Telephone[ —
CONTRACTOR'S NAME/COMPANY
Lic. No. [—_ Class
Contractor's Address
Contractor's E-mail Address
City State F
Zip Telephoned
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. XA2023 AW 1713
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO, PCi.OZ2. ZZp/�"
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
Print Form Worksheet for Combo Building & Solar Permit Application 9
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c,.,.
v
Building F Grading rbrainage XElec j Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood F_ Fire F_ Uq F_ Landslide F_N/A Floor Suite No
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Description of Work AJaj ras f LCfZ /go),7/eJ f4% 191�"V
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#Stories #Units(ifRes)s
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Valuation a {, ` C
Material/Labor "( so,
New/Add SF I Q (`j Remodel SF qC C Garage/New/Add � � 5,'
OWNER'S NAME Last l..�f! I
t,Cl.Ej21 First S�p
Owner's Address Owner's E-mail Address
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City �lit�y�U l' LSL}i�t State
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APPLICANT'S NAME Last =
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last - C z 7 q6 [
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ArchitectIDesigner's Address Architect/Designer's E-mail Address
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City ((C Syr} - State C%iZiP �%ZCJ Telephone
ENGINEER'S NAME Last ' 1I
C, JI�S0j First C Lic No. j 7,0
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Engineer's Address Engineer's E-mail Address
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City CSC tiT State Gt} Zip —?(Y-- Telephone 7/i{_j'7, _C-SZV
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
Contractors Address Contractors E-mail Address
Zip Telephone[ - L(j City State �- p � p � � S'
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. v
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $