HomeMy WebLinkAboutPV2023-0367 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4�E7°°rm
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oa"
rBuilding rGrading
rDrainage rElec rMech rPlum CuvdCut F CuYdFill F
Project Address (Not mailing address) r Flood r Firer Liq r Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type
_
# Stories #Units (if Res)
Valuation $
New/Add SF�
Remodel SF� Garage/New/Add �
J y3
Material/Labor �
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City �
State F_ Zip F— Telephoned
APPLICANT'S NAME
Last First
Applicant's Address
i— Applicant's E-mail Address
City
State Zip F__ Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
C=y�
Architect/Designer's E-mail Address
City I
State F_ Zip F_ Telephoned
ENGINEER'S NAME
Last First 7— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F Zip F Telephone�—
CONTRACTOR'S NAME/COMPANY �,� t r r �� Lic No. 2y Class j f3
Contractor's Address
Contractor's E-mail Address
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City ,,, „_�I a
State Zip ; , Telephone T J 'T %
SETBACKS REAR
SETBACKS FRONT PERMIT NO. P\f ZC1L3 — (DJ67
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
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DEVELOPMENT NO (JCL' v (iZ003% PLAN CHECK FEES $'?C i3 IibJ[y�\
t. 7� v