HomeMy WebLinkAboutM2023-0033 - Permit Applicationrint Fwpo
__PForm __ _ � Worksheet for Combo Building &Solar Permit Application
j- Comm'I (- Residential City of Newport Beach - Building Division
NOTF PI AN C4JCI`It rooc nr i, n ri, —
oV biviii IHL
\%
F_ Building F_ Grading rDrainage
F_Elec (•"Meth F- plum CuYdCut CuYdFillF
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
F
23 }-}f}IZl3ofL ISLAND
Description of Work
Use F Const Type F
R�INi-aZ.�t= EXIs-I-I�� SSW-4u./Ry�KN�,q
# Stories[ # Units (if Res)F
Valuation $
Material/Labor
New/Add SFF— Remodel
SF�— Garage/New/Add �—
OWNER'S NAME Last
1 jC �� I (� First —r0 [)D
Owner's Address
Owner's E-mail Address
2-1N��C72 ISL/a�n)D
City /gEVdfl )Rt
State �—Zip QZ/abO Telephone �y/�—
APPLICANT'S NAME Last
FWasT- First 3>cFF-
Applicant's Address
Applicant's E-mail Address
15Y0 S. coAst 14N
sTE 2-0,9 Ttf i cpyE¢,ca�t
City ZA(,gA)A EE,-CI.J
State �— Zip 72(05/ Telephone 9 yam_
99i 9i&
ARCHITECT/DESIGNER'S NAME
Last
A First F Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_ Zip F_ TelephoneF_
ENGINEER'S NAME Last
yV lG-L Lic. No.
SUM pS iJ l� First j{/t� 538/Z
Engineer's Address
Engineer's E-mail Address
2-3 DPCJ4AcR0
City F_ F-OP�ff-51--
State C/} Zip 9'Z6,3 0 Telephone �y9-1o6- 9971?
CONTRACTOR'S NAME/COMPANY
`tke�� e ov1, t y — Lic No. q?7 Sqb Class f�-
Co//n��tractors Address
Contractor's E-mail Address
:.keJa I cdr,era —. csM.
City Tr v r h G
State C4 . Zip qZ G ( Z Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. MZtr7/3 — OO J 3
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. Z7
USE ZONE
DEVELOPMENT NO O I9 --5 �%{j PLAN CHECK FEES $