HomeMy WebLinkAboutM2023-0078 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F Comm'I jh' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F Plum Cu vd Cuts Cu vd Fil f
Project Address (Not mailing address) F— Flood
r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
Use ConstType
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# Stories # Units (if Res)s
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Valuation $
Material/Labor F2-�)t`z o
New/AddSFs Remodel SFs— Garage/New/AddF_
OWNER'S NAME Last e-A1A LC,FF
First
Owner's Address
Owner's E-mail Address
City IV�+`tip �ti �`- - %�C�•�� State c�°(-..
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Zip q (� (p'3 Telephone
APPLICANT'S NAME Last N
First � 7
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Applicant's Address
Applicant's E-mail Address
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City I?..--� a
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Zip . -' � Se Telephone
ARCHITECT/DESIGNER'S NAME Last
First �` Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State
Zip I Telephoned
ENGINEER'S NAME Last I--- ;11 �;'
First �n � \ 1-� Lic. No.
Engineers Address
Engineer's E-mail Address
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1 L-7Y VIA-vt--)C_c to
City I l-t- qu i in � I jLj C, L, State C A
Zip 1 6-1 2 Telephone ii
CONTRACTOR'S NAME/COMPANY ' �� t l r GPI (f�
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4 - � L l.i i_ -Cl— Lic No. 1q 15� Class
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Contractor's Address
Contractor's E-mail Address
City V ICG�� 1�i li State L
Zip cf Telephone (,IL
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. iC�.9Z�J •njo
USE ZONE DEVELOPMENT NO`E?Jcf�2,.QbQ:::� PLAN CHECK FEES $