HomeMy WebLinkAboutPV2023-0301 - Permit ApplicationPrint Form.. IWorksheet for
Combo Building & Solar Permit A U44"
F Comm'I j Residential Cityof Newport Beach -
p Building Division ppllCation
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j Grading
(—Drainage r Elec r Mech (— plum
Project Address (Not mailing address) f Flood j- Fire Cu Yd Cut Cu Yd Fill
I— Liq j- Landslide f—N/A Floor Suite No
Description of Work F—
Use Const Type (_--
/ 3 KW # Stories # Units (if IRes)r—
New/Add SF�—
Remodel SFF� Garage/New/Add Valuation $
OMaterial/Labor
OWNER'S NAME z31 3f S
Last
Owner's Address First
Owner's E-mail Address
City
State r----
d---
APPLICANT'SNAME
Last Zjp F, Telephone
Applicant's Address First
Applicant's E-mail Address
City
State r—
ARCHITECT/DESIGNER'S NAME
Last Zip TelephoneF__�
Architect/Designer's Address First —
Lic. No. ��—
ArchitecUDesigner's E-mail Address
city r
State �— Zips---
TelephoneF
ENGINEER'S NAME
Last
Engineer's Address First s--
Lic. Nos�
Engineer's E-mail Address
City
State (��_ Zip s----
Telephoner---
CONTRACTOR'S NAME/COMPANY _i Q
Contractor's Address Lic No. 6 S 3 g y<r Class C39 a
83Z p CCJontractor's E-mail Address
Icity � D
SETBACKS REAR
SETBACKS LEFT
USE ZONE
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91 a�js Telephone 7/ 63
SETBACKS FRONT
. PU�z3_ 07QJ
SETBACKS RIGHT
:7PERMIT
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DEVELOPMENT NO I Zd ZZ— �� sgK FFF.c Q