HomeMy WebLinkAboutXR2023-1553 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application U ;=
F Comm'i Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
15�Building r Grading rDrainage r Elec r Mech (— Plum CuvdCut F CuvdFill
Project Address ((}Not mailing address) F_ Flood Fire r Liiq r Landslide rN/A Floor Suite No
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Description of Work 2. �%� ��S
Use ConstType�
ep li os ra l;ict- •{-: l--s t"C'^S� l l � of 17 bs
#Stories #Units (if Res)
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Valuations ``, j
Material/La r 3 b t 7
PLUM uNc'r Gwo a rw,+-
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last �7r�� i zl�rwi l c ti� First
Owner's Address Owner's E-mail Address
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City Cat ��� Ma State ZiP �} Lfi?S TelephoneF' )H -j I-) _)%
APPLICANT'S NAME Last I First
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Applicant's Address Applicant's E-mail Address
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City C, t C i ., c, 1 M,( State Zip Telephone '►l`I ^ Tb n 9
ARCHITECT/DESIGNER'S NAME Last First F--
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— TelephoneF
ENGINEER'S NAME L F� s, First S -ej eti Lic. No. LH cc,`t
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Engineer's Address, Engineer's E-mail Address
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City RQc`\aAc45 State CFv Zip gZ373 Telephone �f DI_ >�i 1-_731 G
CONTRACTOR'S NAME/COMPANY p ` Con t e Lic. No. ��3�' Class
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Contractor's Contractor's, E-mail Address
Address \1
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City I �K� �S' i a,� State I `--" Zip L T lephone C2,-?-7 3E0 j-LIL_j
SETBACKS REAR SETBACKS FRONT PERMIT NO. X uSt J — �—�,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $