HomeMy WebLinkAboutPV2023-0277 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading rDrainage rElec (-Mech
rPlum CuvdCut F cuydFill
Project Address (Not mailing address) F_ Flood r Fire Landslide FN/A Floor Suite No
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Description of Work
UseFF F' 7 ConstType i
--
# Stories # Units (if Res)
New/Add SFF_ Remodel SFF— Garage/New/Add F_
Valuation $
Material/Labor q2S
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City � State �—
Zip F_ Telephoned
APPLICANT'S NAME Last Fi_e,
First
Applicant's Address
Applicant's E-mail Address
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Low:�l(�i�C .,'i�.�-�ti,•t-r`-t- C,c'�7�t.ti
City State
Zip /� 6.S Telephone 7iy-]/,S;jgt??)
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip F— Telephoned
ENGINEER'S NAME Last
First F Lic. No.�
Engineer's Address
Engineers E-mail Address
City State F_
Zip F_ Telephoned
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CONTRACTOR'S NAME/COMPANY ' ! 0 Lic No. ' JZ1 ClassIJ
Contractor's Address
:J
Contractor's E-mail Address
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City G'rState
Zip 2�5 Telephone 7/y bX-7D�
REARM SETBACKS FRONT
PERMIT NO.
EEBA
LEFT SETBACKS RIGHT
PLAN CHECK NO.�
DEVELOPMENT NO
PLAN CHECK FEES $