HomeMy WebLinkAboutXR2023-1394 - Permit Application1 _ _Print Form_ I Worksheet for Combo Building & Solar Permit Application
j- Comm'I r'✓Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
14-06ding r Grading rDrainage F_ Elec r Mech
F_ Plum CuydCut s CuvdFill s
Project Address (Not mailing address) r Flood
r Fire r Liq F_ Landslide rN/A Floor Suite No
109 hu6s.-Id Ave
Description of Work
Use s Const Type s
# Stories # Units (if Res)r
,P�l_ �n e- 'vaCL
Valuation $
New/Add SFF_ Remodel SFF— Garage/New/Add
Material/Labor ok
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OWNER'S NAME Last a
First ahG( Ca(yy
Owner's Address
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Owner's E-mail Address
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City Cocz>,cz Dip,Mc0.r State C4
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Zip Telephone
APPLICANT'S NAME Last LnI
First 0-0_ C+,
Applicant's Address
Applicant's E-mail Address
2 / 1 /L2 0. _n-Q _ Av�
City /je-Dpc3k+ State C=c
Zip g 2-,4-Z Telephone (SSq)7 17 } i ss-
ARCHITECT/DESIGNER'S NAME Last V0.1 V S ��
O,�'l,� First J 2 Lic. No.
Architect/Designer's Address Chi; ,rtiiji,
k,+ec�
Architelc Designer's E-mail Address
/J ( �Q I a` -s Dc -.. _.
�j E i�a4n(ic '�t"G1. G('S • l:-�,^�
City /K¢.$c, State C
Zip C12 (C_ Z Telephone—
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ENGINEER'S NAME Last Ac SLrq
First (-a ryt a Lic. No.1—
Engineer's Address
Engineer's E-mail Address
t 8o u C- (b f- %-e_ e,St- /3
City 1 30-✓1�a c State CGS
Zip 92'?C)( TelephoneF_14)
CONTRACTOR'S NAME/COMPANY lJ�t{2�P� nae
f� j h t�. Lic. No. q 7Y2v Class
Contractor's Address
Contractor's E-mail Address
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C,fie t�Q+"+"-, �Eec- gam.
City N iz,,� p l3 PC, C k State G 4
Zip v( ZE F 2 Telephone C u R) � `{q
SETBACKS REAR SETBACKS FRONT
PERMIT NO. A( �UL� " I �
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. /�C 2aJ,"7 — J-,7W
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $