HomeMy WebLinkAboutXR2023-2143 - Permit Application_ Print Form Worksheet for Combo Building& Solar Permit Application
7' (�,,,nm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(—Building j— Grading rDrainage r Elec
ect Address I
>tion of Work
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r Mech r Plum Cu Yd CutF— Cu Yd Fill
I address) I- Flood r Fire r- Liq r Landslide rN/A Floor
Suite Nc
New/Add SFF— Remodel SF
Use F Const Type
# Stories #Units (if Res)
Valuation
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dd Material/
OWNER'S NAME Last '7o� gf_o / i C_ First
Owner's Address
Owners E-mail Address
city I NO 1,oruiz T—� Ci4r— State Zip �. K2S'Telephone 7/Cf 7
APPLICANT'S NAME Last SJ First
Applicant's Address Applicant's E-mail Address
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City ) ,J?q Y/1ZC Awip, State C'/ Zip ZG2.( Telephone Ss�
ARCHITECT/DESIGNER'S NAME Last "I 045 1 Z
Architect/Designer's Address
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City State F
ENGINEER'S NAME Last I
Engineer's Address S ,� /vl c Al
First W /"JA�,- Lic. No. C/-f5
ArchitecUDesigner's E-mail Address
ZIP F— Telephoned --
First
Engineer's E-mail Address
Lic. No.F` I
City I Sate F— Zip I— Telephone 7—
CONTRACTOR'S NAME/COMPANY SL r C%n No.UClass
—M/W �01 Ct L 7—TNC Sa�l
Contractor's Address Contractor's E-mail Address
City 6646/U/il 126 State C— Zip %2Ga?s Telephone %S/%Jr2y=�7��
SETBACKS REAR SETBACKS FRONT PERMIT NO. X.(Z � jL3 (Cl
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. _ (>
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