HomeMy WebLinkAboutPV2023-0426 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application uf*fe
r Comm'I r Residential City of Newport Beach - Building Division g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c..aw�•'
r Building F Grading rDrainage I— Elec r Mech r Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing
address) r Flood r Fire j— Liq r Landslide FN/A Floor Suite No
ID_15 o�rY,����-
Description of Work
Use Const Type
# StoriesF # Un' s (if Res)F
d 5
AC-- M09WC5
1<',J bC d J
l P� uecwa�i (10'Kwy a? K
Valuation $
Material/Labor S ((
1
New/Add SFF Remodel SF �— Garage/New/Add
OWNER'S NAME Last
L 1 I; O i{ First'l
Owner's Address
Owner's E-mail Address
1 i ` G'A r.\ e'lf
City G0YOV1n N MnY
State FC A Zip Tele�l
1 phone Vb
APPLICANT'S NAME Last
�5_6Jo First CnlkV;S
Applicant's Address
Applicant's E-mail Address
City �—
State F— Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME
Last First 7 Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F— Zip I Telephone
ENGINEER'S NAME Last
I `rJO-A3 First �!�p'�( Lic. No. G7_
lJ
Engineer's Address
Engineer's E-mail Address
City I
State I Zip F_ Telephone[ —
CONTRACTOR'S NAME/COMPANY
I,,\rOnr'.����� < j �i ( Lic No. �c�cf (j Class C-1
/
Contractor's Address
Contractor's E-mail Address
City
State �— Zip F_ Telephoned_
/
5 b'�
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 'Pyul, j�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 1L���j4
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $