HomeMy WebLinkAboutXR2022-2963 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
2-0' ' 2t 6 3 City of Newport Beach - Building Division
j- Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding I- Grading F-Drainage r Elec r Mech
F- Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) F Flood r Fire r Liq r Landslide FN/A Floor Suite No
F 3
Description of Work
Use F—ConstType
VVV\0Jo.. 0
L I
# StoriesF_ # Units (if Res)F_
New/Add SF7— Remodel SFF_ Garage/New/Add F—
Valuation
Material/Labor
OWNER'S NAME Last ok "�
First
Owner's Address
Owner's E-mail Address
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PVDVM L5 t� 111� 0�• C.�YVy
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City State `/
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Zip 2,(o63 Tellephone ]jLf 32�_(%b
APPLICANT'S NAME Last (3� fy�_
First �Q
Applicant's Address
Applicant's E-mail Address
City ^ y" State C-A
Zip �j�(D Telephone l(4)JL(
ARCHITECT/DESIGNER'S NAME Last S y First ��f,/ uo. No. C 1331 Z
Architect/Designer's Address
Architect/Designer's E-mail Address
Co 1 b S, (AM(�n6 l(s_J %e- "I�
Cn-fin✓is C anc,G�✓o�x. i ��,n/n
City ( State C�TA-
Zip ( � :" 2 Telephone A I - J ? 70 I-%
ENGINEER'S NAME Last (,J l 4 \
First Ia t.SJ, Lic. No. L 03
Engineer's Address
Engineer's E-mail Address
Zbl
alex. k .his e uV-au (.,Arm
City ( _lls State ��
Zip CITelephone Itv{)5 7(d (��(�
CONTRACTOR'S/N-A`ME/COMPANY \
t
Lic. No. Class
i� n Y
Contractor's Address ✓ 1
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d1� o trC" St actor`s E-m�Ad�dr�e s�+ram t �✓"1
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City �( � f� J _' State ��
Zip ��LG,3 Telephone .. 3
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $