HomeMy WebLinkAboutPV2023-0076 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application of
Comm'I j Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL I/11 Im 3^ an u� c„
rBuilding F_ Grading j—Drainage i—Elec FMech F—Plum Cu Yd Cut- Cu Yd Fill F
Project Address (Not mailing address) F_ Flood f Fire F_ Liq f Landslide rN/A Floor Suite No
Description of Work
Use - Const Type -
So lv- S I
K,-j (2 �d Pan,is
#Stories #Units (if Res)-
Valuation $
Material/Labor 11
New/Add SF�— Remodel SF�— Garage/New/Add
OWNER'S NAME Last (' Z �cx First C c7
S
Owner's Address Owner's E-mail Address
City ,J ew?cry `7x c State Zi ��
p 71 2663 TelephoneF
APPLICANT'S NAME Last
jfti�1., cel First I /,) , C (,---
Applicant's Address Applicant's E-mail Address
City State FC V 1 Zip := -7-S-S Telephone[: ( i o 5 Z (v 57f—
ARCHITECT/DESIGNER'S NAME Last First �—
_ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— Telephoner
ENGINEER'S NAME Last First F Lic No. ---
Engineer's Address Engineer's E-mail Address
City [ State Zip �— Telephone —
CONTRACTOR'S NAME/COMPANY r�
Y (�y�r/ Lic No. �CS 22 / Class C. ro
Contractor's Address Contractor's E-mail Address
City �q�[ �w(� State Zip Telephone Sig 416 I [
J V irtr[so
SETBACKS REAR SETBACKS FRONT PERMIT NO. 4,V-W)0%"�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �J�yI't✓ 0%)li�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $