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HomeMy WebLinkAboutXC2023-0039 - Permit Application (3)_Pr_int corm Worksheet for Combo Building & Solar Permit Application O EWOO City of Newport Beach - Building Division III^ j Comm'I �I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Y 4Building ❑Grading [Drainage klec ch kPlum Cu vd CutFJ Cu rd Fill Project Address (Not mailing address) I] Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No Description of Work Use [� onst Type I�n�t, ' lr -Tr xcE spaU rf sl sa 1=F #Stories #Units (if Res)C J Valuation S 7->1 D� New/Add SFF' Remodel SF'_ rrGarage/New/Add �� Material/Labor / OWNER'S NAME Last { )�� lrt� First _.I Owner's Address Owner's E-mail Address [{1 e4r,M'v 1 City State (—/ Zip a Telephone • `' ' % f1 OX1 APPLICANT'S NAME Last tflkl" First Applicant's Address Applicant's E-mail Address '7 < s.�U�`�j �t I l •{'1 `�I1' �1/_tic ` �f ,GA'{�. , f i City �7Ii-A�Z.- ` 1 State,/ Zip r 'Z.i�ji�Telephone ARCHITECT/DESIGNER'S NAME Last ��'�C� =�� _ First 1 LkI Lic. No. C ArchitjdectlDesigner's Address ( / Architect/Designees E-mail Address City State Gt"` — Zip C7 57_6 W Telephone C{ l , ENGINEER'S NAME Last —J First - �I Lic• No. I Engineers Address Engineer's E-mail Address I -I — City -- - -__ State C—I Zip —I Telephoned CONTRACTOR'S NAME/COMPANY y. " : :.- Lic. No. ��I� Class --... ----- 6� Contractor's Address I,p Contractors E-mail Address �rn /� /'��p� t State —I ZiP� �{ �S�%I III�VeWvr I-- --! City -IV Ef — --- — ('� 4 Telephon _�'�{_� _7"G� SETBACKS REAR SETBACKS FRONT PERMIT NO. czM330039 SETBACKS LEFT SETBACKS RIGHT ^M PLAN CHECK NO. (ZG^'' G3 -0313 USE ZONE DEVELOPMENT NO 2aL w 00 S PLAN CHECK FEES $