HomeMy WebLinkAboutPV2023-0222 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicatil
r Comm'I j?'�esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL IPVaoa3'
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rBuilding j-Grading
rDrainage rKElec (-Mech
j-Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) r Flood
r- Firer Liq r Landslide f N/A Floor Suite No
Description of Work
Use s ConstType F
# Stories # Units (if Res)s
Valuation S
New/AddSFF_
Remodel SF Garage/New/AddF—
Material/Labor
OWNER'S NAME
Last ) L- `. First
Owner's Address
Owner's E-mail Address
City
State F
Zip �— Telephoned
APPLICANT'S NAME
Last {n:_t. ..
First-1-r tom,
Applicant's Address
Applicant's E-mail Address
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1
L �� �? wry ; 5 ^
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City � ;,�.y.; v,�
State Cry-
Zip '( 17 3 '3 Telephone ?t `( Cj;, s77 6/,
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City I
State F_
Zip F_ Telephoned
ENGINEER'S NAME
Last
First F Lic. No.[—
Engineers Address
Engineer's E-mail Address
City
State F_—
Zip F_ TelephoneF—
CONTRACTOR'S NAME/COMPANY 4-� ei, Lic.No. to'r�,3�, ClassKZ
Contractor's Address
Contractor's E-mail Address
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City ,y 7;
State ,"¢
Zip 7-'-v5" TelephoneF,(
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. �U Zy t/ 1 Q LZZ
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. �Cq cii3 Liv tS
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
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