HomeMy WebLinkAboutPV2023-0378 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application Dq%MWWFj,
r Comm'I r Residential City of Newport Beach - Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r Elec (--Meth
r Plum Cu Yd Cut l F_ Cu Yd Fill
roject Address (Not mailing address) f Flood r Fire r Liq r— Landslide r_N/A Floor Suite No
7
ZLD�I C�,� )t,r:-,(�yiv, hI _0a
scription of Work
//�+ ( c� q / Use s Const Type s
6,,-7 e /5 # Stories # Units (if Res)F—
New/Add SFF_ Remodel SF -- g Gara e/New/Add �— Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City I State F—
ZiP [_ Telephone
APPLICANT'S NAME Last �—
First �—
Applicant's Address
Applicant's E-mail Address
City I State F_ Zip'[— Telephones--
ARCHITECT/DESIGNER'S NAME
Last F First F�
Lic. No. F—
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City
ENGINEER'S NAME Last
Engineer's Address
City
O TRACTOR'S NAME/COMPANY
ntractor's Address
City
State F— Zip F— Telephones --
First
Engineers E-mail Address
Lic. No.s--
State F_ Zip r— Telephones--
n 1 S / CS (l / ✓v �7 Lic No. ;0 z `SU! Z Class
JJ %
Contractor's E-mail Address
State �— Zip F Telephone��
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.� . (�
PLAN CHECK NO.
PLAN CHECK FEES $