HomeMy WebLinkAboutXR2023-1083 - Permit ApplicationPrint Form 'Worksheet fcar t'o.rnoo Building & Solar Permit Application �6WPogA
Comm'I City of
� r Residential ry Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u a
Building j- Grading Drainage 'f�,Elec F/,Mech
(
-PIUm Cu Yd Cut ��Cu Yd Fill
Project Address (Not malling address) C Flood (-r/ Fire Liq [- Landslide [N/A IZ1
Floor Suite No
of Work
Use 5 ConstTypeTT
[�� _
# Stories #Units (if Res)
New/Add SF[ Remodel 51lX�C� Valuation $
` Garage/New/Add �- Material/Labor d0�
�_ p ner -
---
APPLICANT'S NAME Lasf /�� f {�
First
OWNER'S NAME Last /�
Firsf_l.F{-if7_�?�C_--
Owner's Address -- - — - ---__ _
Owner's E-mail Address
City`-_LJ���--- �f✓}(�---.._ State ZIP Tele ho
Applicant's Address
/DESIGNER'S NAME
Address
City
Applicant's E-mail Address
State Zip
Last I First F----
State F Zip
E-mail Address
Lic. No.
ENGINEER'S NAME Last �p
First �j�y Lic. No.
F_
Engineers Address Engineer's E-mail Address
�_ Ud - �--1 !07_�} S'C--- - .. ---- --- - - - —IDA - � 5 t
city — _ ��'1 �� Gd"-�
— --- . -
/l)7/ ACV - -_ State Zip Telephone � _ ... ?— d
CONTRACTOR'S NAME/COMPANY `
I.v�L�No.�� Class
Contractor's Address I Contractor's E-mail dress
q-
tY .;-��( c(coY�
Ci V�� C�S✓ State �- Zip Ct Z�v Telephon 011l
- > u-403-��3/D
SETBACKS REAR SETBACKS FRONT
SETBACKSLEFT SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO,
USF ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
/pw .
��, �,, V-,�s-e -
g to U