HomeMy WebLinkAboutXR2023-0161 - Permit Applicationrani corm __ VVorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building
� Comm'I j— Residential P 9 Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building j-Grading F-Drainage rElec F_Mech FPlum Cu vd cuts Cu Yd Fius
Project Address (Not mailing address) I- Flood (- Fire [_ L' Landslide F_N/A Floor Suite No
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Description of Work
Use s ConstType s
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k �
L� � �' .--Ll-�— A/1 � S cur
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# Stories #Units (if Res)s
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New/Add SFF — Remodel SF
Garage/New/Add �—
Valuation $
Material/Labor
OWNER'SNAME Last I
�' S G +A—
First r_ " lGV1 ✓i'� (�
Owner's Address
Owner's E-mail Addresscitt
--
y State Zip �Telephones
APPLICANT'S NAME Last `` -- ,, vZ i
First
Applicant'sAddress
Applicant's E-mail Address
City I � �)� State
Zip L3U65 Telephone�_ 01.,, A�,
ARCHITECT/DESIGNER'S NAME +
Last � t 2 1^ bCG `�^ First Ct - t) t? Lt,/ Lic. No. (Cp
�7
Archite esigner's Address
Architect/Designer's E-mail Address
C 1
raty
/� r.
f 'V (� L.F �✓� State %
- �--y�- -
ZIP Telephone
GINEER'S NAME Last e First �® Lic NoF—
Engineer's Ad
Engineer's E-mail Address
City �® State F
ZiP F TelephoneF_
CONTRACTOR'S NAME/COMPANY��� �/-
N
L�ro5c��� Lic. No. t�Z�ja Class
Contractor's Address
Contractor's E-mail Address
City ,v 7� State CC
Zip � Telephones
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �� wVI-0 ( C
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �GZd'LTi- Ot S9
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $