HomeMy WebLinkAboutXR2023-0053 - Permit Applicationl Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building rGrading rDrainage [Elec rMech rPlum Cu YdcutF Cu Yd Fill
Project Address (Not mailing address) F Flood r Fire r Liq r Landslide CN/A Floor Suite No
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Description of Work `b, eoyw(,(
Use I— Const Type
rJ�--w 60' o" ?-sDwooz PzoP�,y Lt�,ji_ h;_0,Jcf-
# Stories #Units (if Res)F
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Valuation
New/Add SF � Remodel SF � Garage/New/Add MateriaULabor
OWNER'S NAME Lastl First[ JoHtj
Owner's Address Owner's E-mail Address
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City State Zip `IZ,6Z5 Telephone (310�
APPLICANT'S NAME Last Mtw7n rs'
Applicant's Address
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City I 0E_v"Pm--t State t✓1�
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Applicant's E-mail Address
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Zip Ig2(p lv O Telephonel C2o2;�
ARCHITECT/DESIGNER'S NAME
Last -- pJ MAD First C��I G� Lic No. l—
Architect/Designer's Address Architect/Designees E-mail Address
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City B015f_ State D Zip ��j})(p Telephone (I�j Zf(-IbbQ)3
ENGINEER'S NAME Last ip:o1-7-- First To N t - Lic. No, 47-ro z-,: -
Engineer's Address Engineer's E-mail Address
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City ��f3Tlti{C11OAF VfLFtC}1 State Zip 1Z,(p4(Q- Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. I00_ -353j ClassF
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Contractor's Address
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City ►�r__WvolT ��RL}�1 State GA
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address
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Zip �Zip(P � Telephone CW q j"7Z?jl - v)+
PERMIT NO. W1�3 - ooS3
PLAN CHECK NO. 10 ! l
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $