HomeMy WebLinkAboutXR2023-0034 - Permit ApplicationApplication Dqs_ml,
Print Form � V�'orksG�eet foa�` C®mbo Bui'9ding &Solar Permit App rCity of Newport Beach - Building Division Zz3 iF-�idential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1 03
Gradin Draina e [- Elec Mech Plum Cu Yd curl Cu Yd Fill F
(Building � g � g
Project Add ess (Not mailing address) f- Flood r Fire F_ Liq F_ Landslide rN/A Floor Suite No
'�Z .7�A�' �J2�J J%'Zl Use �G Const Type
Description of Work %
IZ ee, d V ��� %� ��t �r( j y� � � , # Stories # Units (if Res) ,
4_1/ ` f
A ,� av; � yr i rL voez; .._ _ l /��s-ter
New/Add SF
OWNER'S NAME
/Z
Valuation
S /
R�del SF ��� Garage/New/Add �— Material/Labor
Last `7irf2 /�G'//V -� First
Owner's Address Owner's E-mail Address
City State Zip �— Telephone
1
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
lsev tJz 't ....... .............� �' � hut. f�c7--------- --- __� C'. .. .... .. .o`er
Telephone
City /i GTaO� `SCAN D State l � .. .....
Zip �f �/�'f First 716ARCHITECT/DESIGNER'S NAME Last `/flCL�
/ n� Lic. No 2 ZZ
Architect/Designer's Address Architect/Designer's E-mail Address
-T-�"-` CityF, 77-- — ----- Zip Telephone
state P
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
State Zip F__— Telephone
City
CONTRACTOR'S NAME/COMPANY
Lic. No. s ClassF_
Contractor's Address Contractor's E-mail Address
City State F_, Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. �4VZ 3 �`Qo3Q
PLAN CHECK NO.
SETBACKS LEFT SETBACKS RIGHT �CZO23•I�U� 1
ni nni ruCr`1! CCGC y: