HomeMy WebLinkAboutXR2023-1385 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application @14
r Comm" IV City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading rDrainage F_ Elec r Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood j- Fire r Liq F_ Landslide f N/A Floor Suite No
Iv
Description of Work
Use f 2 ConstType V�
# Stories #Units (if Res)FF
�-ui cn Flo� 1 P � oM; Its
t1 �1nU�C�a�1lty/
Valuation $ N-
Material/Labor ` o i Ct�
�
New/Add SF� ZI Remodel SF Z Garage/New/Add i A
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OWNER'S NAME Last
�f P 0 c� 4M(}t.�
First °� CW
Owner's Address
Owner's E-mail Address
3 a5 t NJe-
City 'c '3, o tL State F
Zip c� Z,I;tE 1 Telephone 002�pj
APPLICANT'S NAME Last M t VCS
First
Applicant's Address
Applicant's E-mail Address
1'
elk cce SS pnu 1. C44
City /Je, u, wv,yu, State I En
Zip Ct 1b1 Z Telephone q-� J- S3ko 3313
ARCHITECT/DESIGNER'S NAME Last—
fl
First ,
Y 5�� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
y(Y1 b ?C4
IZ_ bNVz?z. o3m
City �Qy ti pp, ,4 State �—
Zip qZ�FZ I Telephone C5c}j z21,- 1130
ENGINEER'S NAME Last �j 1
First Lt Lic. No. C.(, 7r/b
Engineer's Address
Engineer's E-mail Address
City Ali p, �'� j State
Zip " i2ie,') TelephoneFT-fc - 22-lLo. I Y
CONTRACTOR'S NAME/COMPANY {
t,CC.eSS �1�
Lic No. �(p(p5y Class Q
FfeejCQ- J\
C.fl
Contractor's Address
Contractor's E-mail Address
jj��
h\ 1�C1 CJ. �OCCA f��QSSunC��
CCCC$5r. ILp �f�A,�,.t.ow.
City SQh Lek v11R 1Z State F�
Zip e t-L 1 L Telephone C� 51 1�3 ;) 332�
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. P!, �Z S
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $