HomeMy WebLinkAboutPV2023-0201 - 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
i- Grading Drainage 70ec F-Mech F_ Plum cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) C Flood
'3°II 23rd
Fire [ Liq i- Landslide [N/A Floor
New/Add SF�— Remodel SFF— Garage/New/Add 7-
Suite No
Use Const Type
# Stories # Units (if Res)F_
Valuation $
Material/Labor
OWNER'S NAME Lastl CjiokruFirst) (Lapnot -fA -_
Owner's Address Owner's E-mail Address
City State �— Zip [— Telephone 7 t �� _ �q
APPLICANT'S NAME Last I To
Applicant's Address
City I t Pw ng c v_\ State C
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
-- --- - - _-. _ -- --- -
City State F—
ENGINEER'S NAME Last L
Engineer's Address
C ity
State
First i Even o.
Applicant's E-mail Address
Zip 'tz,5_1,- Telephone 3 b oo -Oi`L-3
First— Lic. No.
Architect/Designer's E-mail Address
Zip �— Telephonel
First Lic. No.[—
Engineer's E-mail Address
- - - ---
Zip [ — Telephone)
CONTRACTOR'SNAMEXOMPANY > Lic. No. N, Class cto
Contractor's Address Contractor's E-mail Address
`110 we5 f -
igdth _Jiro Y -- - o�{av_tu�olrz _0._
City Toirl. ,C-4 State (p` Zip yp �O Telephone (0 - 6�0 455w
SETBACKS REAR SETBACKS FRONT PERMIT NO. ` V/►YV
Q1, -/
SETBACKS LEFT SETBACKS RIGHT PLAN CHECKMb
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
111
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