HomeMy WebLinkAboutXR2023-0666 - Permit ApplicationPrintForm_I Worksheet for Combo Building & Solar Permit Application (6=Q�,,
F Comm'I Residential City of Newport Beach - Building DivisionP
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 14ZMnL
F-Building [ Grading FDrainage f- Elec F_ Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood r Fire C Liq F_N/A Floor Suite No
�jr7Landslide
Description of Work
Use F7 Const Type F_
# Stories # Units (if Res)
��—
Valuation $
Material/Labor
New/Add SF� Remodel SF Garage/New/Add
-
OWNER'S NAME Last First-
Ow�nees Address Owner's E-mail Address
Aae_-�5;,rev
City Q � �� State Imo'-' Zip �S )P n - Telephone[C, Vlr�
APPLICANT'S NAME �Lo
Last vAU_��....----- � First
--
Applicant's Address Applicant's E-mail Address
.-.T_.�------- M�r£i��lrar�c,k�rf C��MY'tIL (_orn,
City _ K State Zip Telephone
�2�Z� ���1-�.��� 27'% L
ARCHITECT/DESIGNER'S NAME Last First F77777 Lic. No. F7777
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F TelephoneF—
ENGINEER'S NAME Last LAB G� FirstLic. No.�
Enginee(s Address Engineer's E-mail Address
IA)e
City � State I Vr Zip ( L1J_ Telephone
'll
CONTRACTOR'S NAME/COMPANY �' b `i Lic No. 0Gi?--� F
P� 4�aEi _ arlST t.� lass.
Contractor's Address Contractor's E-mail Address
//
11V W aa;�37 TV 71 -r_
City r� v
�fh�T State I ., Zip Z(II� Telephone C. c4 r2'7UL
1
SETBACKS REAR SETBACKS FRONT PERMIT NO. (K D 0 a 3- O 6 6 6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. VC — 'b
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $