HomeMy WebLinkAboutXR2023-1062 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building r Grading rDrainage r Elec r Mech
r Plum CuvdCut F CuYdFlll F
Project Address (Not mailing address) f Flood r Fire r Liq r Landslide F_N/A Floor Suite No
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Ca. F
Description of Work
Use F_ Const Type
q
# StoriesF_ # Units (if Res)[_
Valuation q �I 0�
bor \ l
Material/Labor
New/Add SF �— Remodel SF F Garage/New/Add �
OWNER'S NAME Last / f o
First
Owner's Address
Owner's E-mail Address
I L tt 3 & 5�} r 9 c
City ✓Ve—rol- &,,4 State (,�
Zip cj262b Telephone F�aiiiZ7-7RSf
APPLICANT'S NAME Last �1,e� g e\r
First v-n --{—
Applicant's Address
Applicant's E-mail Address
r
11�-b �fintei-or\ vfiv` 5� to
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City State C.4
Zip t®2ll y Telephone (?60� 5'?3 --11 U,
ARCHITECT/DESIGNER'S NAME Last �laHa^� First Erie Lic.No.�
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
ul/p4, T<vAescr, O
el,�?..r @ creQpasI 5. c��
city Corovtal State C'�-
Zip q2a{�3 Telephone b�15) 32(�- 8`l9�
ENGINEER'S NAME Last Q�4\yy
/
First S�-V���" Lic.No.0 g13
Engineer's Address
Engineer's E-mail Address
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3s �3 'E, I%1oft�b ST
r'
Siv.r/ G�h �lnak �. [ o�
City L t Caen �{ y State CW
ZipF t ZI � Telephone Ft3) 8_2-t7 - 0006
CONTRACTOR'SNAMEGOMPANY i<canS'�'r�ct�•-,
>L�Ie✓''�'S Lic.No. FT I Class
G,
Contractor's Address
Contractor's E-mail Address
U 2D (fir hLe��� ''Dr.
City I tv\" -Iq (nJ '�.ty State I"q
/
Zip Fp-veli Telephone l))573-�Ifk
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X r"i3OZ�j . tC�ID 2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. }�' G 7 O23 (kTSn
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $