HomeMy WebLinkAboutPV2023-0096 - Permit ApplicationV ✓ I' V D41 M 04'.
Print Form Worksheet for Combo Building & Solar Permit ApplicationComm'I j Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r` Building ( Grading (-'"Drainage (_ Elec ( Mech ( -- Plum Cu Yd Cut F Cu Yd Fill
Project Address (Not mailing address) I� Flood r Fire F- Liq F Landslide rN/A Floor Suite No
Zqd//V/
4 F
I
Description of Work
LI `'`
Use F—Const Type
S
# StoriesF # Units (if Res)r��
00 N"�D j 7-WAO) (/V )OOP Job P/It-
_19IM1,04-11
Valuation $
Material/Labor /
New/Add SFRemodel SFr
Garage/New/Add �—
OWNER'S NAME Last
---
First F ff
Owner's Address
Owner's E-mail Address
City StateFC
Zip F326 I0 Telephoner3
APPLICANT'S NAME Last I���
First,
Applicant's Address
Applicant's E-mail Address
City ��' �����f//� State
Zip ��, Telephone fu(p,VZ21- Z�
ARCHITECT/DESIGNER'S NAME Last
— First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State
Zip Telephone)
ENGINEER'S NAME Last
-
First r Lic. No.
- - - --- - O
Engineer's Address
rU w
Engineer's E-mail Address 0
City � � State F
Zip -- -- -- Telephoned-_......._�,
CONTRACTOR'S NAME/COMPANY � %�� , Lic No. ��d`�� Class
Contractor's Address
Contractor's E-mail Address
City � �f State RW
Zip � ' �S® Telephone ko -
SETBACKS REAR SETBACKS FRONT
PERMIT NO. C)CA (�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $