HomeMy WebLinkAboutPV2024-0087 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ofWComm'I r Residential City of Newport Beach -Building Division�NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL„
r-Building r Grading r-Drainage r Elec f-Mech
r Plum CuydCut F CuYdFill F
Project Address (Not mailing address) i- Flood
r Fire r Liq r Landslide i-N/A Floor Suite No
Description of Work
Use F—Const Type F_
ti u t 7 -�t1�v Y 6.Crt AA CY 1__
# Stories #Units (if Res)
New/AddSFF— Remodel SFF— Garage/New/AddF—
Valuation $
Material/Labor \[j
OWNER'S NAME Last `Lv�l.r, or
First
Owner'sAddress
Owner's E-mail Address
ll_\ titi , C t c Z
City t.» �r}� �.� State P r
Zip �— Telephone�—
APPLICANT'S NAME Last vj'L Ci,
First v,,-<115
Applicant's Address
Applicant's E-mail Address
,
\ J$"t- V�t�FI'�i i`L. Jtv, S,g =
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City F�1,��-, State 77,'i
Zip �i gD Telephone 77,j 1
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F—
Zip F TelephoneF—
ENGINEER'S NAME Last
First F_— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. ' - :' o Class
:ns5 ( x Srr:� ,x
Contractors Address
Contractor's E-mail Address
C.
City � State F
Zip I Telephone
Q Ot?
SETBACKS REAR SETBACKS FRONT
PERMIT NO. (,g
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $