HomeMy WebLinkAboutXR2023-1362 - Permit ApplicationPrimFgrrn -I — .,, Worksheet for Combo -Building & Solar Permit Application (514-A
omm I �sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFR nl IF AT TInnG nr a ionnirTni
j�j ilding F Grading [—Drainage r Elec F_ Mech Plum l` I�
Cu Yd Cut l Cu Yd Fill I
Project Address (Not mailing address) C Flood f— Fire f Liq f Landslide [_N/A Floor Suite No
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Description of Work
Use ConstType !/
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# Stories # Units (if Res)
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New/Add SFF— model SF %�C� ��� Garage/New/Add F—
Valuation $ !�
Material/Labor `���� c
OWNER'S NAME Last /ff/," //27L�j�,'� CO First —'
Owner's Address —� -
Owner's E-m 'LAddress
City _ -- State �—
-- Zip �— Telephone— —`
APPLICANT'S NAME Last F77Y� First A y
Applicant's Address Applicant's E-mail Address
City, L�QA �Gj1i� State fr Zip Z��2 Telephone
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ARCHITECT/DESIGNER'S NAME Last �,� /C=� First J �l ,� Lic. No 2 27
Architecf/Designer's Address Architect/Designer's E-mail Address
City Zip Telephone —
ENGINEER'S NAME Last First F® Lic. No.F—
Engineer's Address Engineer's E-mail Address
—
City F State �� Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY Lic No. �J f67 q Class
Contractors Address Contractors E-mail Address
City State �— Zip I Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. )C It2U2� ►I Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (aGZi0
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $