HomeMy WebLinkAboutPV2024-0147 - Permit Applicationy Print Form_ Worksheet for Combo Building & Solar Permit Application
Comm'I cC� }2esidential City of Newport Beach -Building Division!
C" NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building F_ Grading F-Drainage j—Elec F_ Mech
r Plum CuYdCut F CuYdFill l
Project Address (Not mailing address) F_ Flood
r Fire r Liq F_ Landslide I -N/A Floor Suite No
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Description of Work
Use F.7 ConstType F_—
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# Stories # Units (if Res)s
Valuation r" J\
Material/Laa bor ->_1
New/AddSF� RemodelSFF Garage/New/Add
OWNER'S NAME Last �� I� Mf ^Y I,�G First
Owner's Address
Owner's E-mail Address
City T�t(1� State Ill'
ZipC1•� Telephone __1z,,Cn1_N
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APPLICANT'S NAME Last aL
Applicant's Address
Applicant's E-mail Address
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Zip Q1��6� Telephone "l13LfSr
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State F_
Zip F_ Telephoned
ENGINEER'S NAME Last
First FA—.f,)W Lic. No. F (8>
Engineer's Address ` Ct)WO;( ��E��QIt Engineers E-mail Address
City Tzt(SW-L5UI� State 1 E
Zip (d-u') Telephone qF �� l
CONTRACTOR'S NAME/COMPANY S S_,r /fin
C7d�J�1(Z [ I�� Lic No. 9203 Class -
Contractor's Address
Contractor's E-mail Address F'
125_ COWeI31A NE gUit-FAC Lo1A
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City TZic)i�Q-S toi� State l Ui
Zip Telephone �t—_5
SETBACKS REAR SETBACKS FRONT
PERMIT NO. V 11 l I-
SETBACKS LEFT SETBACKS RIGHT
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PLAN CHECK NO. �� ] av k— U�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $