HomeMy WebLinkAboutPV2023-0098 - Permit ApplicationPVq10,,Z;_00qq
Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm] jv Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL < oar
r Building r Grading j—Drainage r Elec r Mech r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire r Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use F Const Type
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#Stories #Units (if Res)
Valuation $
New/Add SF � i _Pie W Remodel SF Garage/New/Add F—
Material/Labor 1 dr U� 0
OWNER'S NAME Last First I b&R,,eA1_
Owner's Address ( Owner's E-mail Address
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APPLICANT'S NAME Last First t /V
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Applicant's Address Applicant's E-mail Address
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City i'l�S,q State 1 cq Zip 4 Z,,) Telephone q&o. -qq1 - 3,133
ARCHITECT/DESIGNER'S NAME Last SA,U k iiS fl pp" (,9—•1l' First Lic, No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Telephone
ENGINEER'S NAME Last � First �� � 5 Lic. No. 61 ((-63
Engineer's Address Engineer's E-mail Address
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City II�A-/JGtf� S�NT� jAh_j�6A_j?,tr*tate l � Zip Z,496 Telephone qq�`
CONTRACTOR'S NAME/COMPANY �Z \Zt L C Lic. No. 16 Zq Z67- Class
Contractor's Address Contractor's E-mail Address
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City State F Zip Telephoned_
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 'yy� `
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N7• PLAN CHECK FEES $