HomeMy WebLinkAboutPV2023-0028 - Permit ApplicationPrint Form ,� Worksheet for Combo Building & Solar Permit Application
r Comm'l XResidential City of Newport Beach - Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL'QU )Oa3. 00?K
F-Building [ Grading Drainage �'lec F Mech Plum cu yd cut Cu Yd Fill
Project Address (Not mailing address) [ Flood r- Fire F- tiq [ Landslide F_N/A floor Suite No
Description of Work Use %{3 rti Const Type
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# StoriesF # Units (if Res)F
Valuation $ 1 ea 04 O
New/Add SF�— Remodel SFF77777 Garage/New/Add F7777 Material/Labor
OWNER'S NAME n
Last � f r L -.:.. - First ...��_ --- -----------
Owners Address Y Owner's E-mail Address
L
_�� _:.1__.-(f`f �ISo�`I-�- �t�.__ _._.__—. _ OC.�(Li�(l kJGC,U�oV��'�f �'J-�°►�, Co/7'I
tCity State M Zip r j f,�- � c Telephone
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APPLICANT'S
NAME Last �j� First
Applicant's Address Applicant's E-mail Address
1
City L._State I ` Zip 9(S Telephone
ARCHITECT/DESIGNER'S NAME Last First
Architect/Designer's Address
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- - - -.
City State
ENGINEER'S NAME Last rLt v n �j
Architect/Designer's E-mail Address
Zip Telephone
Lic. No I
First O r-) Lic. No. %O'%8
Engineer's Address Engineer's E-mail Address
oeo _ Sr-0��7' Sr�Zo I n o
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City C�.iz✓�-- State C,& . Zip 0 Telephone g ,783'4 4&5
CONTRACTOR'S NAME/COMPANYt j /, , C �5� y Lic. No. 159 Qlass �p
Contractor's Address
—14
City _ _L 1 j State l
SETBACKS REAR
SETBACKSLEFT
USE ZONE
SETBACKS FRONT
Contractor's E-mail Address
Zip gZ&Ile Telephone `�� /`3 'j �z-,
SETBACKS RIGHT
DEVELOPMENT NO 1)w
PERMIT NO. XQA DtyO�PVf6f11,p0h8
PLAN CHECK NO. jt.Ul1 . p(I�
PLAN CHECK FEES $