HomeMy WebLinkAboutPV2023-0255 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(-'Building r Grading
rDrainage F- Elec F Mech
r Plum CuYdCut F CuYdFill F
Project Address (Not mailing address) r Flood
F- Fire F- Liq F- Landslide F_N/A Floor Suite No
W �$0` S�
F_ F_
Description of Work
Use F—ConstType r
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# Stories #Units (if Res)
Valuation $
New/Add SFF
Remodel SFF— Garage/New/Add
F—
Material/Labor
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State F_
Zip F Telephoned
APPLICANT'S NAME
Last / ✓eQ.E/O D/� / �frcst
Applicant's Address
Applicant's E-mail Address
City I
State I
Zip [ Telephone[—
ARCHITECT/DESIGNER'S NAME Last
First F F _
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
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 TelephoneF_
CONTRACTOR'S NAME/COMPANY At1ye I I I uG 1`lk✓`�D j Lic. No.Floz y6 y y Class �r �N q
b
Contractor's Address
Contractor's E-mail Address
43445 Zu5in(55
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pefr���Soray9y reet�r�� teVe�-C�w.
City I If M f_LL jtk
State Ga
Zip gITelephone 7 i y- 315- 57Hj
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. % Z
USE ZONE
DEVELOPMENT N
PLAN CHECK FEES $
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