HomeMy WebLinkAboutXR2023-3571 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F Grading F-Drainage r:):Elec F_Mech
( Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) r Flood
r Fire F_ Liq [_ Landslide F_N/A Floor Suite No
qll e' (J . Alt-5
F
Description of Work
Use ConstType G(-?
CC1Vri�iZ OXFsiu,� SIGLIC0% F7_vtt. -U�
(Mid e &iJ CLOY6
# Stories #Units (if Res)
Valuation V� c'L'
Material/Laa bor <�> t
New/Add SF Remodel SF Garage/New/Add e/New/Add
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OWNER'S NAME Last �jr{�/Vi
First f i l6tifaCZ 17AO �AM
Owner's Address
Owner's E-mail Address
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City State t-i
Zip Telephone) q _ C2 _Z6&E-y
APPLICANT'S NAME Last
(r
First 00(gO
Applicant's Address
Applicant's E-mail Address
23i�3 CA C1 )q- (fin- T+(01
DAVIOI` orLO- 6W
CitY I [A6viJ4 1-ktLS State Fon
Zip ? ee'� 3 Telephone ?q (y- - 5_73; 46
ARCH ITECT{DESIGNER'S NAME Last First 1!J
y' �� Lic. No. C ,17t4 d
Architect/Designer's Address
Architect/Designer's E-mail Address
CA CADC-'� oQ
DPWO 0 rxuAZCrJ. a1!
City C f� �4 IIJ4 jjL) State t'./I
Zip Z/ ,, Telephone �C15 - , -'7,7- 3�
ENGINEER'S NAME Last L4`('�_e
First Lie. No. Cr:.3"7T3
Engineer's Address
Engineer's E-mail Address
Z �;o zZ CA Cr/ti r� D2
City I t66uN�} RckS -- State '511
Zip Y26S 7 Telephone lef—•570 - F -2�
CONTRACTOR'S NAME/COMPANY / I J0�\� �i Class
1,L t.S Lic No. F_
(/ r I
Contractor's Address
Contractor's E-mail Address
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City l o /�l State
Zip c�-1� Telephone R7 10)
SETBACKS REAR SETBACKS FRONT
PERMIT NO/R O (,5 —3 7
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC ZS
USEZONE DEVELOPMENT NO
PLAN CHECK FEES S