HomeMy WebLinkAboutXR2023-0154 - Permit Applicationrint �orrn 'Workshebt for Combo Building & Solar Perniit''
Ap licatibn
L P0 W
F��COmm,l FLR6dential City of Newport Beach - Building Division
MnTC: PIAN KI rUE=r'V ECErc,
DUE AT TIME OF SUBMITTAL
F�-Xl I d i n g Grading [-Drainage F- Elec jW Mech
Project A"s (Not mailing address) f- Flood
F- Plum Cu Yd Cut Cu Yd Fill
F- Fire r- Liq f- Landslide F-N/A Floor
Suite No
F
Description of Work 4t A
Use
Const Type
FA
//V/,--, -
New/AdcISFI.—..... . .-
OWNER'S NAME
A —7 V
B* m-o-de' I S F
/ /, s UL- / # Storiesl _;� # Units (if Res)[ t','7-11
. AA�
Valuation $
Garage/New/Add F7 Material/Labor
Last //—,2 411;11f- Q First
Owner's Address
., . ...,. , .''. .....................................................
City State I
Zip Telephonel,
APPLICANT'S NAME Last 1,A > First
Applicant's Address Applicant's E-mail Address
I
1-2, -V e _j
......... . .
City 11W11 T��/S;OState Zip F7 Telephone . . ...... ...........
ARCHITECT/DESIGNER'S NAME V -
Last I IZ-A FirstF7 A JL�)/:) Lic. N
� - . , I .. .. 0(f
Arch itect/Designer's Address Arch itect/Designer's E-mail Address
. . . . ........... .. ............ . ... ... . . .........
City State zi3O Telephone
ENGINEER'S NAME Last First F Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Qot�l( .0 Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone F
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO,
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $