HomeMy WebLinkAboutPV2023-0484 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading ["Drainage �(Elec rMech
r Plum CuYdCut CuvdFill F
Project Address (Not mailing address) F_ Flood
F_ Fire r Liq r Landslide r_N/A Floor Suite No
Description of Work
Use F—Const Type F
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` Q 70�a` \
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S ories� #Units (if Res)
V
Valuation$
Material/Labor I V
New/Add SFF— Remodel SFF— Garage/New/Add F_
OWNER'S NAME Last e�
First
Owner's Address
Owner's E-mail Address
city �f \ �/! m I �-'T State
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Zip 2t� ''3 Telephone
APPLICANT'S NAME Last t--0 e>
1 lV CC
First 0� v,�.` ' .��
Applicant's Address
Applicant's E-mail Alddress'`'1
J OW` va � .L
City `t\wt State E
Zip Telephone[
ARCHITECT/DESIGNER'S NAME Last ` NN& (L' j
First of CO Lic. No. F—
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Architect/Designer's Address
Architect/Designer's E-mail Address
ry y
City ��p0 CC) State
Zip Z f-LP Telephone �I - �, - I j yS
ENGINEER'S NAME Last �� J fjt
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First :� rho) Lic. No. 1 t s�Ll
1
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY v^\\�\p
1.
O` f. Lic. No Ij�i,;`Jim` � �j Class 40
V
Contractor's Address
Contractor's E-mail Address
[ 1
city N F\77wae State
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Zip F1-LU13 Telephone ���� Z� -J I
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61
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.���
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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