HomeMy WebLinkAboutPV2023-0110 - Permit ApplicationPant Form11 Worksheet for Combo Building & Solar Permit Application sqp-�Wzv
Comm'I DC Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building [- Grading
[—Drainage WElec [-Mach [- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r' Flood [- Fire r' Liq [- Landslide [-N/A Floor Suite No
5 seine
F F
Description of Work
Use r- ConstType r
# StoriesF_ # Units (if Res)[ —
0 Kw J
Valuation $
New/Add SFF
Remodel SFF Garage/New/Add F
Material/Labor
OWNER'S NAME
Last r y I/f� el-n First
Owner's Address
�
v Owners E-mail Address
Sej 77 E
City �OW)0ri Coofgt State r C_� Zipr L6�% TeleIIIphone Ty kgoly3
APPLICANTS NAME
Last �jG, , , en ��7
First of y
Applicant's Address
J� Applicant's E-mail Address
ty r ( eel
Ci_--2, lY- t Ccac�- State C} Zlp NTS 7 Telephon�
ARCHITEC/T//__D.�ESIGNER'S NAME Last First F— �-
Lic. No.
ArchitectlDesigner's Address
Architect/Designers E-mail Address
City I
State F__ Zip F Telephoned
ENGINEER'S NAME
Last First F Lic. No.[
Engineers Address
Engineers E-mail Address
City
State r Zip F— Telephoner —_—
CONTRACTOR'S NAME/COMPANY Lic No. r ClassF—
Contractors Address
Contractors E-mail Address
City
State F Zip F TelephoneF
SETBACKS REAR
SETBACKS FRONT PERMIT NO. `PY23 2-3 '- Olt V
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $