HomeMy WebLinkAboutXR2023-2532 - Permit ApplicationPrint Form I 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
rBuilding j Graavg (-Drainage r Elec F Mech j- Plum
Cu Yd Cut
Project Address (Not mailing address) r Flood r Fire r Liq F Landslide
2039 PpR� ct-(�L_s�t �1
Description of Work
RIV�wR`T R�Pc�c£M�/ i -
New/Add SFF --- Remodel SF
Cu Yd Fill F
(-N/A Floor Suite No
Use F— Const Type F—
# StoriesF_ # Units (if Res),
Garage/New/Add F- Valuation F'.
Material/Laabor
OWNER'S NAME Last nl A I LA 66 First f` t t N
Owner's Address
Owner's E-mail Address
I q-71 fro QT C�-te71�F ��. / n J • ncr-Ha,d � vD i d�sly com
City �. i3�_ .,e H State r V _ Zi
P Telephone q4q er33 2-5-4,6
APPLICANT'S NAME Last
Applicant's Address
2o3�t Poa=� C1-c���Ft 'P�c�
City I h1f_WPo2( 612flc.fl State �-
ARCHITECT/DESIGNER'S NAME Last
First I " t C_b (.
Applicant's E-mail Address
4611 b 5 ii urki „-, j et �j e C3
ZIP 0 Telephoned e133 N6 6
First F� Lic. No. F�
Architect/Designer's Address Architect/Designer's E-mail Address
City State �- ZipI— Telephoned ---
ENGINEER'S NAME Last
Engineer's Address
First
Engineer's E-mail Address
Lic. No.F--
City I State I— Zip F — Telephone[�
CONTRACTOR'S NAME/COMPANY IsOu� LAY I_.� r�'DS Lic No.
� c�+� `1�392g aa5s�—
Contractor's Address coN S>7,t.�,1 orj.
Contractor's E-mail Address
�11+V'on;Lro ydtgoo.CnkV1
City State-- Zip F Telephone 'l14 �� 8t2�
SETBACKS REAR SETBACKS FRONT PERMIT NO,
I
TBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �v
ONE DEVELOPMENT NO
PLAN CHECK FEES $Pe%e6 �Lw l