HomeMy WebLinkAboutPV2022-0367 - Permit Applicationf V OU-o-�)(PI-
Worksheet for Combo Building & Solar Permit Application
j- Comm'I r-,R/esidential City of Newport Beach - Building Division `3
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
4uilding (- Grading rDrainage r-V�Iec r- Mech
F- Plum Cu Yd cut Cu Yd Fin
Project Address (Not mailing address) f- Flood
Fire I- Liq j- Landslide F_N/A Floor Suite No
I qaA%oe, �Jw oa aac u
IV I
Description of Work
Use Const Type r
0 Gar no
m) E)w,(-d01brCI
# Stories #Units (if Res)r—'!
Valuation $
Material/Labor
11
MCvu-t,10) U-19 �_W NO MP4
New/Add SFF_ Remodel SFr- Garage/New/Add r�
OWNER'S NAME Last
First F�-aNk�
Owner's Address Owner's E-mail Address
City State CCt Zip Telephone f p • _ 7L
APPLICANT'S NAME Last /U1�
First
Applicant's Address
Applicant's E-mail Address
2, 7 D C(�� M05 u.
0W� ' sCV ih,e I ra a IT Pelh d es .. C001V
City uv�r �� /�/�d State � � - Zip
�j� � b Telephone��.7 , Z G� 1 c��(' 2 G
ARCHITECT/DESIGNER'S NAME Last �—
First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
city State F� Zip
Fy; Telephoned
ENGINEER'S NAME Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State Zip
I Telephoners
CONTRACTOR'S NAME/COMPANY �I p
(Lic. No. 1 DKb? Class / - �
L `T
Contractor's Address
Contractor's E-mail Address
ZZ 70 COVY1 U� Gl
City ���(� b�� �' State 7X Zip
Telephone 42 lJvq I
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $