HomeMy WebLinkAboutPV2023-0215 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
(— Comm'I r Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r—Building j— Grading rDrainage r Elec r Mech r Plum CuvdCut CuYdFill F
Project Address (Not mailing
address) r Flood r Fire r Liq r Landslide FN/A Floor Suite No
l u o l S Qn fi a y b
p,- F- [----
Description of Work
Use F—Const Type
(ASlt/list 2 t(06N 501+, My (t,S w/ 52 Atcto,
# Stories[ # Units (if Res)
Valuation $ FO O
(n5lgl)t.t9 CoMb/nPr� f p1SCoA�r�1'—
New/Add SFF— RemodelSFF Garage/New/AddF—Material/Labor
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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city /vPwpbl+ pestCh
State P Zip -I j�i60 Telephonel4�lgl v33-Sz Y�
APPLICANT'S NAME Last
First
S YR4�i (i"
Applicant's Address
Applicant's E-mail Address
901 4IeAAPY/P '51
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City (� 414 A' �. [
State L _4 Zip �%6 51 Telephone 512 631 7,(57
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F— Zip F— TelephoneF_
ENGINEER'S NAME Last.fl.(.t..,..��_._.e
First y ji Lic No. b'87P3
Engineer's Address
M 4A ygA2i2 F_y,eAf
Engineer's E-mail Address
ecfs 4Qet, eA'in Pors ADl: corn
City
State F— Zip [_ Telephoned
CONTRACTOR'S NAME/COMPANY
S q I Ip COI 4 / D e5 151, Lic No. Fq8L533 Class "/{6
C� J
Contractor's Address
Contractor's E-mail Address
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City J3 ew ch
State (✓�— Zip 9�.65 Telephone (qyq) S8y—Qs
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $