HomeMy WebLinkAboutPV2023-0263 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL VV 10a3
rBuilding j- Grading rDrainage r7Elec r Mech
(— Plum CuvdCut CuydFill [_
Project Address (Not mailing address) (— Flood
r Fire r Liq r Landslide rN/A Floor Suite No
J-5-q I vC-C 12
1 1
Description of Work �.. `;O
Use �ConstType �
# Stories #Units (if Res)
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C
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C+N
New/Add SFF_ Remodel SFF— Garage/New/Add F_
Valuation $
Material/Labor F2��c Lti
OWNER'S NAME Last 1 u 5,c v i >n kx 1
First -Z V C'n
Owner's Address
Owner's E-mail Address
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City o.C.(, �E�toy State C}y"
Zip y72 6c; Telephone
APPLICANT'S NAME Last _Pin, tv,,- ----
First V
Applicant's Address
Applicant's E-mail Address
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City C% (act„ '. ----- State
Zip T2 �t Telephone F4-(Cl _? -;e -� b 22
ARCHITECT/DESIGNER'S NAME Last �
First F_ Lic. No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City I State I
Zip F_ Telephoned
ENGINEER'S NAME Last �
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
Clty State �—
Zip Telephone[
CONTRACTOR'S NAME/COMPANY t ��¢c {- '.�C`�„{
Lic. No. F 71 2.:1-c Class U—
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� 1ti C
Contractors Address
Contractor's E-mail Address
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City .. . � State C
Zip FL _ Telephone ���--2,Z -5Lr2�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �v( a' �Z_
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. %lL LJJ 16_tV
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $