HomeMy WebLinkAboutPV2022-0360 - Permit ApplicationRriat Form Worksheet for Combo Building & Solar Permit Application
Comm'( [_' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[_Building [_Grading r-Drainage I-;,Elec [_,Meth I-PlumcuvdCut I CuvdFill I
Project Address (Not mailing address) [_ Flood [_I Fire [_'; Liq r Landslide [_N/A
Floorr Suite No
Z 3 Z 0 RC H-I u Avw 6 R-o t.;A (cL_ Matz, C?,- qu zS I 1
of Work
Zq ?1fMcwur� PV AbDVu6S WITIA WCa,0IAI✓ER--,rrMLC
q a- ? ITT SOL, ES
New/Add SF F,, 6 VAN Remodel SF F—Garage/New/Add
Use F— ConstTypeF—',
# StoriesF_ # Units (if Res) ;
Valuation $
Material/Labor
OWNER'S NAME Jy1 660
Last w T Mh N First IV� A R K
Owner's Address Owner's E-mail Address
Q � 2 ov-cvH0 Avz
City l A{Zop h �t t _IMA State FT Zip 12d7.i Telephone
APPLICANT'S NAME Last l B A-t2gq-
Applicant's Address
G"> 3 N S.�j 1tALL Sr
City I CWT.t- LA"k _ State FFF_
First I VtN
Applicant's E-mail Address
Vlti Q 9I2-1/ntfTbiFESof-AA.coM
Zip cf-z76 Telephone q6s-qgi- 3v7
ARCHITECT/DESIGNER'S NAME Last First F_
Lic. No.
Architect/Designer's Address
City State—;
Architect/Designer's E-mail Address
Zip I Telephonel—
ENGINEER'S NAME Last I K DrA-1,F,5 First FDo ✓ 6z Lic. No. 60163
Engineer's Address
S VIA- B.FCMo1.7r$
City I2016%, SA, -IPA MFdkA-1rTA State
Engineer's E-mail Address
i_
Zip ..q2698 Telephone[qy9- zss_s/oy
CONTRACTOR'S NAME/COMPANY < Lic. No. (62�j 2,6? Class g G y(
?1LlHti7 LIFE JDLAt- t
Contractor's Address
g
City I 61-5TA iAESA, State orc-A
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Vwe 801�FPT-LIFE5ot-,�,R, Go
Zip 7 Z6 7,4 Telephone
PERMIT NO. f Mz2-V.36 �r�a�ozz-2SLI8
PLAN CHECK NO. rC20ZZ-Z6gS
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $