HomeMy WebLinkAboutXR2023-0716 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
n Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading rDrainage rlElec rMech ❑Plum CurdCut F7 CuvdFill C
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
0`63 2 '_,� \\usoe —\Dr I L I
Description of Work Use CI ConstT
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Ccep q" \ to S�ujn `,. # Stories # Units (if Res)s
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,n�trn�xoi—i' cs2F, chi- lJs'� Valuation $
New/Add SFRemodel SF TI _ - Garage/New/Add Material/Labor
OWNER'S NAME
Last �Q'�°\-�,D _ First . _vw;0.,n
Owner's Address Owner's E-mail Address
City Ne Q, R State ! (f:A7 Zip q�y 0 Telephone
APPLICANT'S NAME Last\, fl __ First
Applicant's Address
City �& State
ARCHITECT/DESIGNER'S NAME Last
ArchitecUD�esigner's Address n^ -
jpi\ Ct'W.l° --- II
City i����-ram_ _ � State
ENGINEER'S NAME Last
Engineer's Address v
City State I
Applicant's E-mail Address
Zip _ g IXji Q, j Telephone Sr<j2 - 56b'Z6os
First - �\ Lic.No.-`''$3I
Architect/Designer's E-mail Address
a5O42CO C MSY1 •covvi _
Zip 9��.j Telephone 6b2lt-7 .�
FirstLL�No
Engineer's E-mail Address + --
Zip F Telephone
CONTRACTOR'S NAME/COMPANY LUf of c7J- &T Lic. No. - O//4 G is ass
Contractor's Address
`eal PIIEG1147V Arz - -
City _JI)b-LA PJ4`%1Z Slate
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
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Zip 9G-p�/ Telephone d/y ���_ _�3,0
PERMIT NO. X20 `L7 - b1 I U,
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $