HomeMy WebLinkAboutPV2023-0112 - Permit ApplicationPrint Form g g pp
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orksheet for Combo Building &Solar Permit Application 00—
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(— Comm'I (— Residential City of Newport Beach -Buildin DivisionNOTE: PLAN CHR:K FFFC ni iG ar-rinnl nr 1I L,,..�-r
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F—Building r Grading f—Drainage (— Elec F_ Mech F Plum
Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood F_ Fire (— Liq F_ Landslide F_N/A Floor Suite No
5 72 E o (w F,_-
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Description of Work w►J p Use � Const Type
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i, V f er) � } ���A ) #Stories # Units (if Resf
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New/Add SF�— Remodel SFr Valuation $
Garage/New/Add— Material/Labor 10�Q
OWNER'S NAME Last I C p First J
Owner's Address
Owner's E-mail Address
City FIVFLv fo(4 - IP (QCII State (/i
_ Zip Telephone (j 'l,
APPLICANT'S NAME Last CO/1 �fPras First Xofw,
Applicant's Address Applicant's E-mail Address
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( 49 1/11 t4 C� State C Zip 2 6 5 1 Telephone C S (vZ,) c 3'i
ARCHITECT/DESIGNER'S NAME Last
First F— Lic. No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephoner
ENGINEER'S NAME Last Lo�� Li
First�Q 5�
U c. No.
Engineer's Address Engineer's E-mail Address l
City State �� Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY1_5 1 5C 1 Q% VQ I e 1 GP 1 / W y6
9 (I ��i� in li 1— Lic. No. a Sj�� Class
Contractor's Address Contractor's E-mail Address
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City L y p rl "� c q q State Cr
IL Zip q Z# 5 1 Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. t�I tiD%a bI I7i
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NOQ
USE ZONE 2a21 . C4 {oZ PLAN CHECK FEES $