HomeMy WebLinkAboutXR2023-0126 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading F-Drainage [_ Elec F_ Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F- Fire r Liq [_ Landslide FN/A Floor Suite No
I0`7 0K\�, 1 D
F—
Description of Work
Use [_ ConstType I—
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I�iL W i) OP LEE _ (c 004T 2615
2 p /�
4'RPA ci. k71 U
# Stories # Units (if Res)FT
REAg
�,18h
Valuation S f
Material/Labor , I SOO16b(�
New/Add SF Remodel SF F—Garage/New/Add �
OWNER'S NAME Last �I J� DQ �� 1�W First J�I,VOT �: �4 nr l
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Owner's Address
Owner's E-mail Address
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f�reri� � eh�+,w11jA01o>P. CoW1
City R� U�4 � A State e/�
Zip Tale 'I
H41 S6
APPLICANT'S NAME Last j�j First D R_e;,;'VV —
Applicant's Address
Applicant's E-mail Address
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a) G(r_�4 Il, L, net
City IC ;,) Ak-A-<,State `-" '
Zip G Z-bZ-1; Telephone % b75- /SZ
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
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Architect/Designees Address
ArchitecUDesigner's E-mail Address
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City I w •' W i�j 4 p �_J, ALA-r, State rt—.A
Zip 2,4j yt j Telephone C/ b7; - S / S Z
ENGINEER'S NAME Last F-CIF oT�z_
First a�,2 e5yV Lic. No. [ 0 1
Engineer's Address
Engineer's E-mail Address
City State �
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
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Lic. No. �j t 2 ClassFj—
Contractor's Address
Contractor's E-mail Address
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City Cot& /t/// OIL M41CState F C/!
Zip �2`2f TelephoneSay -37 3?�
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT leo1.
SETBACKS RIGHT
PERMIT NO. xv-so"-0 okv
PLAN CHECK NO.
USE ZONE DEVELOPMENT Np�p PLAN CHECK FEES $
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