HomeMy WebLinkAboutPV2023-0191 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o EW�RrQ
r Comm] r Residential City of Newport Beach - Building Division A702� -
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL ,..."
F- Building r Grading j—Drainage r Elec r Mech r Plum CuYdCut F CuYdFill F
Project Address (Not mailing
address) F_ Flood F_ Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use F_ ConstType I
# Stories #Units (if Res)
Soiac L�S�UA�IOV
9.35o i/"j PG
Valuation
New/Add SFF_ Remodel SFF_ Garage/New/Add
$
Material/Labor
OWNER'S NAME Last
First I F. ; Clv� tier
Owner's Address
Owner's E-mail Address
City
State F_ Zip F— Telephoned
APPLICANT'S NAME Last
P. 5 First ��SQ
Applicant's Address
Applicant's E-mail Address
City
State Zip F Telephoned
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City
State F_ Zip Telephone F
ENGINEER'S NAME Last
First F_ Lic. No.�
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip I Telephoned
CONTRACTOR'S NAME/COMPANY
'JArhgy, L-�her� J S-Dicqr Lic. No. `1 `f l it S Class F —i u
Contractor's Address
Contractor's E-mail Address
City I
State F_ Zip F Telephoned
PU?aZ 3 • O 19
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. �tY6?; • 07�'/2
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $