HomeMy WebLinkAboutPV2023-0344 - Permit ApplicationPrint Form Worksheet for Combo Building $ Solar Permit Application o�EW�ae
j- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building Grading j-Drainage F_ Elec (- Mech
r Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) i- Flood
r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use ConstType Fmy�e—
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l5 V
#Stories '� #Units (if Res)
Valuation $
Material/Labor ^ Z t LI
New/Add SF Remodel SF Garage/New/Add F
OWNER'S NAME Last "' t
First
Owner's Address
Owner's E-mail Address
S
\ �a
n
'I'L 'VIinY I
City `N j , State S
Zip 2 ,I Telephone - 1 q I —, I ' U
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
n
a, : _
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City ��10, State
� 1
Zi'�l`.,�� Tele honeF��t �!'-17
ARCHITECT/DESIGNER'S NAME Last First F_
Lic. No.F_
Address
ArchitectlDesigner's E-mail Address
City State F_
Zip F_ Telephoned
ENGINEER'S NAME Last V 1 Pi��1 it1
` V VJI
First 1L Lic.No. _101 S
Engineer's Address
Engineer's E-mail Address
City State
Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY �\�Z`n
Lic.No. l�ljClass �t�lp
5
Contractors Address
Contractor's E-mail Address
177 Q a ' ^n r
city n,� State
Zip 1 'Telephone
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SETBACKS REAR SETBACKS FRONT MIT NO.
SETBACKS LEFT SETBACKS RIGHT
U PLAN CHECK NO.
/
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $