HomeMy WebLinkAboutPV2023-0124 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF�£ °°rm
j- Comm'I j_ Residential City of Newport Beach - Building Division n�11 nO-
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Y e( 1y U
Building F_ Grading F-Drainage [_ Elec j-Mech Plum Cu vd Cuts Cu Yd Fill F
Project Address (Not mailing address) C Flood F_ Fire F_ Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use s Const Type s
Azli�i(..-
# Stories # Units (if Res)s
Valuati$
La or o orcNew/AddSFs- f
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Remodel Garage/New/Adds—Matena
OWNER'S NAME Last
Firstl_ c 1
Owner's Address
Owner's E-mail Address
7
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City I ✓ 'fUl . State F. ;`
Zip ` 5�(4) % % Telephone ' T/ 7� - e(l;
APPLICANT'S NAME Last a ,� ,; �j'S',!
First
Applicant's Address
Applicant's E-mail Address
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City L1L,% State �'" a'i
Zi (J/. Telephone ' ( t - !'
ARCHITECT/DESIGNER'S NAME Last FirstLic. No. ^
raj
o i F_r
�G7
Architect/Designer's ner's Address
9
Architect/Designer's mail Address
City State �—
Zip r Telephoner
ENGINEER'S NAME `� ��
Last (. i'�,_% �J First 1L ,/ C Lic No.
/
Engineer's Address
Engineer's E-mail Address
f f
City 7 1 State L/ l �-
Zlp ? Telephone t{'r iy. S7c Ll
CONTRACTOR'S NAME/COMPANY /'
Lic No. �— Classs
Contractor's Address
Contractor's E-mail Address
City State
Zip Telephone
SETBACKS REAR SETBACKS FRONT
��nZ`TJ PERMIT NO. /"/ 9l-OZ;�? 01041
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0. 10Z�-Cjl��y
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $