HomeMy WebLinkAboutPV2023-0477 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application
r Comm'I 17N Residential
NOTE:
City of Newport Beach - Building Division
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
1 f Building F_ Grading rDrainage rElec r Mech
F Plum CuYdCut CuYdFill [_
Project Address (Not mailing address) Flood
r Fire F_ Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use I rl J Const Type r V0
#Stories #Units (if Res)
0,00� woftir-ea 506f 4J 1 MiG/b in✓C!�[!S
. rJ� 13.SW oanalS
Valuation p
New/Add SF Remodel SF Garage/New/Add a/New/Add
3� g
�! (00/t
Material/Labor ! l>
a
OWNER'S NAME Last S�
First I Carly
Owner's
Owner's E-mail Address
/Address c
3�10 �2� d
lr �ObsO/13f0@gMai � CoM
City State
Zip q� 3 Telephone
APPLICANT'S NAME Last r `5�e�
FirstSe.1
Applicant's Address
Applicant's E-mail Address
`t/O t - G.. P410,& ,A"e, sFB
CD 15..4%eft~by S-OLS010-r ot. Ce4.1,
City State I (aQ
Zip C(Z$O"( Telephone $F!^ 3/4'0Oq
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. �—
Arch itect/Designer's Address
ArchitectlDesigner's E-mail Address
City State �—
Zip Telephone
ENGINEER'S NAME Last
First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State �—
Zip— Telephoned
CONTRACTOR'S NAME/COMPANY 5 � RHrCGlrs Lic. No. (s333* Class r_ {j
�S
Contractor's Address
Contractor's E-mail Address
City i1.�a „` State F�,47
Zip 12,gjp� Telephone %1�3i(r—Vgbl
SETBACKS REAR SETBACKS FRONT
PERMIT NO. PVZ®Z3 0477
SETBACKS RIGHT
PLAN CHECK NO. PCZ 6Z3 —Z1`
SETBACKS LEFT
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $