HomeMy WebLinkAboutXR2023-0564 - Permit ApplicationL Print Form y Worksheet for Combo Building & Solar Permit Application
F- Comm'I F-,/l� �3 ^�56� City of Newport Beach Building Division
Residential - o _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c', „„.•
uilding [ Grading f—Drainage F_Elec F_Mech r Plum CuYdCut l CuYdFill o
/Project
Address (Not mailing address) C Flood F_ Fire (— Liq F_ Landslide CN/A Floor Suite No
DescriptionDescription of Work
Use Const Type
# Stories # Units (if Resf
5' P,�Jrm
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Valuati or(j,
SNew/Valuati n $ F�2Z,
Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last ���-�� FirstJt!Y\ 52)f SUe� _
Owner's Address Owner's E-mail Address
City, State Zip Telephone y - - - -- y9 - 9y3-� 95e 3
APPLICANT'S NAME Last �py�>\ Firsti�e
Applicant's Address Applicant's E-mail Address
City State F Zip F Telephoner
ARCHITECT/DESIGNER'S NAME Last q First �OsJeG�- Lic. No. �-
Architect/Designer's Address Architect/Designees E-mail Address
City Ll1 FD« 6� -- - State �_ Zip I Telephone - qe_j- �LfZ- ICI Z
ENGINEER'S NAME Last Mev rn First Lic. No.
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Engineer's Address Engineer's E-mail Address
Pin I `
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City yin �tn c State �sti Zip7-6 %7i Telephone q0\'+, S
CONTRACTOR'S NAME/COMPANY L�f)n / - ^/ � t� Lic. No. �3$g l Class
Ccco��ntractor's Address Contractor's E-mail Address
City N , (1j , State I Zip l do Telephone�ZZ,-_2-7 l i
SETBACKS REAR SETBACKS FRONT PERMIT NO. XIM9 O:lo Li
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO G ZQ ZjJ-Lq 716
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $