HomeMy WebLinkAboutPV2023-0376 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ��'°�>e
r Comm'I Residential City of Newport Beach - Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.2� k'
Building r Grading I -Drainage rElec i-Mech
I- Plum Cu Yd cut[_ Cu Yd Fill
Project Address (Not mailing address) F- Flood F- Fire I Liq I- Landslide F_N/A Floor Suite No
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Description of Work
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# Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SF1I& `.1' Remodel SFF Garage/New/Add F—
OWNER'S NAME Last 1 E-7 fi/ws[ ws` t First (fir
Owner's Address
Owner's E-mail Address
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City eW 4 State
Zip Telephone
APPLICANT'S NAME �,A�
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First
Applicant's Address
Ap licant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
Lic. No.
First F— �—
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F_ TelephoneF_
ENGINEER'S NAME Last M �iJ�
First- - Lic No. QZ` DO
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY //.✓J / —
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Lic No. D�y /Q1� Class
Contractor's Address
Contractor's E-mail Address
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City / State I�r
Zip U7� Telephone! 7/�,, 1
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.y W - D =JAI u
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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