HomeMy WebLinkAboutXR2023-1974 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application
r Comm'I (v, Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK. FEES DUE AT TIME OF SUBMITTAL
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rBuilding rGrading rDrainage Elec Mech
17/Plum cuvdCut F_ CuYdFill [_
Project Address (Not mailing address) F Flood
r Fire r Liq r Landslide rN/A Floor Suite No
i:-I ,y; s r.4=:N,'t s.• C- i. GtiVh. �. .l'-/ .. �� '"Jlt ,' �i✓
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Description of Work
Use � {,{ Consi Type FV'�
# Stories #Units (if Res)
.
Valuation $
Material/Labor
New/Add SFF_ T7 Remodel SF , `' �/ Garage/New/Add F
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OWNER'S NAME Last ,! ;(�--;.F`-L�
First
Owner's Address
Owner's E-mail Address
City '., `. ,6r, roc"Hr State ;t�-
Zip-l-%iS�s-�- Telephone
APPLICANT'S NAME Last c ('1,i v
First
Applicant'sAddress
Applicaanfrs E-mail Address
r } r� y (
F,T 1 (,' V'l� IVY
j' / (yj j
nl'. uY,; L f,i \l J t.i�. �. Y• • l-.VfY {
City �4'I:✓J State rti��-
Zip rTelephone F��I.I-t�,"'�<:�'C,�
ARCHITECT/DESIGNER'S NAME Last r .' y � - E{ 4 First .-: r_:,?tt -,Ni Lic. No
Architect/Designer's Address
Architect/Designer's E-mail Address
t �
E'., d . i . i (L .: �,�n , '•C(4
City 'C<,,(A j..jtfy State '� 4
Zip-"I''':-j Telephonej`-Ft� ';-7
ENGINEER'S NAME Last Lh �'`.� (;,�
First LiNo(•t� .`I,=!
Engineer's Address
Engineer's E-mail Address
City ��;v4Af�, State (.�,
ZipF1?.�jil Telephone'tL:1
CONTRACTOR'S NAME/COMPANY 9iLty }z� TopATlGN Cj*jtwh=`jpp Lic.No. jo f `-qj Class
Contractor's Address -
Contractor's E-mail Address
T€ 1N!r—V L ttin �
City ,`{�i,? fi% IA State ! "
Zip �� 7 Telephone lit"1 - q,4; I-i-6e'
SETBACKS REAR t>f SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
I I PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $