HomeMy WebLinkAboutPV2023-0133 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ��°°R>
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Comm'] � Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project (Not mailing address) C Flood
F- Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use [_ Const Type
It Stories # Units (if Res)[_
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Valuation $
Material/LaborVf/�
New/Add SF Remodel SF
Garage/New/Add �—
OWNER'S NAME Last C'� ��Gr� First �apj S
Owner's Address
Owner's E-mail Address
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City AZjvo1e{ (ic-c A State C,4
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APPLICANT'S NAME Last ,�, J-2�.
First V;telvp
Applicant's Address
Applicant's E-mail Address
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City Q State
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Zi Tele hone l 4- -?02 -'3 4 22
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ARCHITECT/DESIGNER'S NAME Last First �—
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Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip TelephoneF—
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F
Zip I Telephone
CONTRACTOR'S NAME/COMPANY cd
- ( ti c Lic No. of 4190 Class C/(a
ay
Contractor's Address
Contractor's E-mail Address
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City
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vQ�,1�rT State C�
Zip �Z$(1 Telephone 4 wZ-642Z
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. PC2M.,3'(!)S7
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $