HomeMy WebLinkAboutXR2023-0479 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r City of Newport Beach - Building Division
Ccmm'i Fv-4esidential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oa."
Building [ Grading rDrainage F-Elec [Meth F- Plum CuvdCut F_ CuvdFill e
Project Address (Not mailing address) (- Flood r Fire F- Liq r Landslide F_N/A Floor Suite No
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1321 - - �-
Description of Work
Use Const Type e
# Stories # Units (if Res)F_
=A1T �R10R Rix M OU51_�rr'Y��LTLTL MSO
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Valuation $
New/Add SF�— Remodel SF Garage/New/Add
Material/Labor �j 8Da
OWNER'S NAME Last �L-� First
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Owner's Address Owner's E-mail Address
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City ;.i pojq 6b#,,4_4 State Zip 9a66 Z Telephone 7oA
APPLICANT'S NAME Last Q First �� M
Applicant's Address Applicant's E-mail Address
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City Ay2_(_�t 4 State IUD Zip Ctl b Telephone.zZ2-897 --d?6a_3
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F__ Zip F Telephonel
ENGINEER'S NAME Last First - Lic. NoT
Engineer's Address Engineer's E-mail Address
City F_ State F Zip e— Telephone
CONTRACTOR'S NAME/COMPANY Slt_h �O /M DI ��� Lic No. G'g3 O Class
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Contractor's Address Contractor's E-mail Address
lS1o_S f-ifr-TFk-A __- _--_-- -- �t►`�1.2M<_CPs �Or-t
City 'AR t A,,0 t State Zip G11 DW Telephone 2-
SETBACKS REAR SETBACKS FRONT PERMIT NO.AZOZ3- ON74
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $