HomeMy WebLinkAboutPV2023-0068 - Permit ApplicationPrint Form- orksheet for Combo Building & Solar PermitAppiieatio�(c/
F_ Comm'I r Residential City of Newport Beach - Building Division qv�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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(—Building [ Grading F—Drainage r Elec [" Mech F Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood r Fire F_ Liq r Landslide FN/A Floor Suite No
203 3 Cad q 1 s 4. (.-- F-_
Description of Work _
Use ConstType
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# Stories F_
Units i Res)F_
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C O,SCGrl� �c t
SF( Remodel SF[ Garage/New/Add —
Valuation I
Material/Labor��
OWNER'S NAME LastV G J z First . � p V j 1
Owner's Address Owner's E-mail Address
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City l Y 7 y/ p t/ i 13 C (i // StateiA _
•I I L Zip b3 Telephon
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APPLICANT'S NAME Last if,rm 5 First xq i Ii e l
Applicant's Address Applicant's E-mail Address
City `9 gUAiKCh State / Zi
✓ p `�L L 5 /— Telephone F15 eL)-�
ARCHITECT/DESIGNER'S NAME Last First F —Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F— Telephone
ENGINEER'S NAME Last First Lic. No.F_
Engineer's Address Engineer's E-mail Address
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City State F— Zip Telephoner
CONTRACTOR'S NAME/COMPANY I, e S G 1 y Lic. No. 7,? C 33 Class Ct qh
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Contractor's Address Contractor's E-mail Address
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City 4 i li l jj bt State ( Zip 2 E f Telephone (9
SETBACKS REAR SETBACKS FRONT PERMIT NO. / >L7 -- & u( ,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �v — U 77
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $