HomeMy WebLinkAboutPV2023-0336 - Permit ApplicationPrint Form 1 Worksheet for Combo Building & Solar Permit Application
F_ Comm] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
04,
Building F_ Grading F-Drainage rTElec F-Mech F-PlumCuYdCut F CuYdFill
Project Address (Not mailing
address) F_ Flood F Fire F- Liq F- Landslide F_N/A Floor Suite No
Description of Work
Use F—Const Type F
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SA" y S! 38 MilkI/Cy- I� �' iad S
# StoriesF_ # Units (if Res)F—
_
Valuation $
New/Add SFF— Remodel SFF— Garage/New/Add
Material/Labor
OWNER'S NAME Last
a &Acl 0 First -F1e
Owners Address
Owner's E-mail Address
City IAVJP04 Nsewk
State C4 Zip az663 TelephoneF
APPLICANT'S NAME Last �q1 First
Applicant's Address
Applicant's E-mail Address
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city �orCrgdr�
State M Zip 01 (7u1, Telephone F�gl)SYso o3s3
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Arch itect/Designer's Address
Arch itect/Designer's E-mail Address
City I
State F_ Zip F_ Telephone F_
ENGINEER'S NAME Last
First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephone
CONTRACTOR'S NAME/COMPANY
�jOIAr Lic No. /bout Class G-/o
J
Contractor's Address
Contractor's E-mail Address
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—A
City
State FM Zip DI a641 Telephone ggg- ae� Yybq
SETBACKS REAR
SETBACKS FRONT PERMIT NO. d'l�o2Q�j
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $