HomeMy WebLinkAboutPV2023-0621 - Permit ApplicationPrint Form
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I Worksheet for Combo Building & Solar Permit Application
F/ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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j� Building r Grading rDrainage iv Elec r- Mech r Plum cuYdCut F CuvdFill F
Project address (Not mailing address) i" Flood r Fire j- Liq r Landslide F_N/A Floor Suite No
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Description of Work `1
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Use I— Const Type F_
# Stories # Units (if Res)
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Valuation
Material/Labor
New/Add SF�_ Remodel SF Garage/New/Add
1
OWNER'S NAME Last
iciv)° h First
Owner's Address
Owner's E-mail Address
City i�_ ,U,J)__ W i c',\n
State C k Zip `(Z.(_,(,ci Telephone
APPLICANT'S NAME Last
t , � ,) i-it�> . First V i k 2., r_
Applicant's Address
Applicant's E-mail Address
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il
City �, t , c. r SS f _ n
State C: Zip r�Z. C, t P Telephone L5 4 2
ARCHITECT/DESIGNER'S NAME
Last First I� Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address .
City I
—
State F_ Zip I TelephoneF
ENGINEER'S NAME Last
First Lic. No.1
Engineers Address
Engineer's E-mail Address
City---
State �— Zip �� Telephoned
CONTRACTOR'S NAME/COMPANY
r r,`k Lic No. �L, .rr Class (I
Contractor's Address
Contractor's E-mail Address
City , „ , ; V,_.
State , zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. • Oue-LI
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. �Y8'✓Yj . �J�
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $