HomeMy WebLinkAboutPV2023-0337 - Permit ApplicationPrint Form ; Worksheet for Combo Building & Solar Permit Application V[- Comm'I [-ResidentialCity of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of WorkL
Use s Const Type F
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#Stories #Units(ifRes)F_
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Valuation $
New/Add SFF_
Remodel SF�Garage/New/Add F_
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OWNER'S NAME
Last L7Cc0cf I e First &,r e 0117 In
Owner's Address
Owner's E-mail Address
City
State Zip F- Telephoned
APPLICANT'S NAME
Last First 1 ✓i f
Applicant's Address
Applicant's E-mail Address
City �
State Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F_ Zip F_ Telephoned
ENGINEER'S NAME
Last First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F- Telephones
CONTRACTOR'S NAME/COMPANY SC i Lic. No. '�y j(5 Class C-�
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Contractor's Address
Contractor's E-mail Address
City
State I- Zip ryTelephonei
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SETBACKS REAR
SETBACKS FRONT ry, PERMIT NO.
SETBACKS LEFT
f�
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $