HomeMy WebLinkAboutXR2023-1723 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application O'6WN"O
j'-�Comm'I Viesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
"uilding r Grading [-Drainage r- Elec r Mech
r Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood
r Fire r Liq r Landslide r_N/A Floor Suite No
�CxG
Description of Work z
/2�64377 `$_ 4
Use--�j�ConstType �/-f'j
/z-� cv� .4,i;> /zs- c�+c �/ " T ��
X ��yi'• /2/� . Cx
if StonesF # Units (if Res)�f
/ram A6 c S A 4, 9 C t�-�- ��G
/sT- � o `zii,� �%cc�u �'% �r� /� •�.t,
/1/5ui.�r �s /�
^v
.
y�cw
Valuation $ IT/h.-�of rz
Material/Labor
New/Add SF� / Garage/New/Add
OWNER'S NAME Last %7-/`G-- //?-A /ti
C First
Owners Address
O - ai Address
City State F
Zip F TelephoneF
APPLICANT'S NAME Last
First ^ y
Applicant's Address
Applicant's E-mail Address
fceze/ cc�,
City I 11�Ilz7e 4 S t:a,uD State F�"A
Zip FF'Z Telephone �/`R f - 2e,5 - e5,5�
ARCHITECT/DESIGNER'S NAME Last /'IZ"i ��%
First r,11 /D Lic. No.
- y Z¢�c�
Architect/Designer's Address
Architect/Designers E-mail Address
City
Zip TelephoneF—
ENGINEER'S NAME Last
First F— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY a
Wvq-. A _ Lic. No. A_4W__ ClassF_
Contractors Address
Contractor's E-mail Address
City State F—
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �%%7 • ���3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $