HomeMy WebLinkAboutPV2023-0246 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4R
F_Comm] F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��,.o.�"
F_ Building I- Grading rDrainage r Elec r Mech
r Plum CuvdCut CuYdFill F_
Project Address (Not mailing address) i— Flood
r Fire r Liq r Landslide rN/A Floor Suite No
2-7 C 671 Fl ) nr lL b�c&J Pm- P �, C `91-
Description of Work
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Use � ConstType
/ r �
Q VNU j -� 4 - Y^ A r-45
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AS,✓ik�) P
#Stories #Units (if Res)
Valuation $
Material/Labor to
New/Add SFF Remodel SFF-- Garage/New/Add F_
OWNER'S NAME Last �, Ae j��;�t,�
First I \ -J I L
Owner's Address
Owner's E-mail Address
ess
31-7
State AF�t�L,� C�
Zip�(e elephon
APPLICANT'S NAME Last MPXW^
First r ft,4(9
Applicant's Address
Applicant's E-mail Address
7� 3 C---D0� (7
A I l/'Nj V-) 0G0 f ,41,-CI I
City - IL, ' IJ State I (J i
ls� J
Zip r 23 �' Telephone ' �_ ZJ Z 1 '7 3 9ARCHITECT/DESIGNER'S
NAME Last (/y^L � N n t F Lic No.
64
Architect/Designer's Address`I
Architect/Designer's E-mail Address
V a (� I ul�/
City `� , F n • � , t IL State
G
h
Zip (� / � Telephone '7r ` _�il (�
a `f
ENGINEER'S NAME Last
First �l Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY f 9,N I A!n r` . 7�r v Lic. Nc� 1.f' O �� Class
V �/ c.J "mil I '
Contractor's Address
Contractor's E-mail Address
� � 3 etA� n,� « 2
I j NrU-r �� �11 �� � t r �u / " �
(tom-C) MLI State I`---(
/1.
Zip Telepho e �'r_ ,;j — I--,,5
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 1�2l/?,O"/
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
-02
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