HomeMy WebLinkAboutXR2023-2228 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application r r o;E� °
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading F Drainage f-/Elec r-Mech r Plum CuvdCut s CuYdFill F
Project Address (Not mailing address) I- Flood r Fire (- Liq i- Landslide rN/A Floor Suite No
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Description of Work
Use ConstType s
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if Stories # Units (if Res)s
New/Add SF w a Remodel SF 33(i 0
Garage/New/Add Nll�
Valuation $ c"
Material/Labor 1 ," Lck
OWNER'S NAME Last Gar rlt.l-
First ff �ti1irt elt'r(��
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Owner's Addresss�
Owner's Address
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)E-mail
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City I A/ e Y'U pe, r'CCc,c k, State Fla Zip ,� a~ Telephone ZL� -
APPLICANT'S NAME Last sv,:4 �Cj/i kejjl afr
First I 011q,
Applicant's Address
Applicant's E-mail Address
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City o.(Act_ A-VCA State
Zip `t5'7C'i t1 Telephone
ARCHITECT/DESIGNER'S NAME Last A bva,,, First FmehilaA Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
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City V ( NEF State C /'c
Zip cj ;z (,c 1 fs Telephone F7 3
ENGINEER'S NAME Last /Y7p�r°i-T
First F6i Yrt Lic No. 7.5-8 ffL{
Engineer's Address
Engineer's E-mail Address
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JiV1P�ri C'IiicKer�iriP ✓�'=Cs
City V, /vG State
Zip F2 4, / 4 Telephone 31 U -k 3 3- 71a7
CONTRACTOR'SNAME/COMPANY %n,. C,I ,-LfliGt�
Lic No. '; Classy
Contractor's Address
Contractor's E-mail Address
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City i\n,✓iy7� Apt State FA
Zip FT71+ _TelephoneW1{ 1-��f�'"�/�Q�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 33 2 2- Z S
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. j2C Ze S I'IS 7
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $