HomeMy WebLinkAboutPV2024-0171 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF�fw °arm
j— Comm'I Residential City of Newport Beach -Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `+�,.oa�"
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j— Plum CuYdCut F CuYdFill s
Project Address (Not mailing address) F_ Flood
j— Fire j Liq r" Landslide FN/A Floor Suite No
Description of Work
Use F—Const Type s
# Storiess # Units (if Res)s
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Valuation $F
New/Add SF1RemodelSFs Garage/New/AddIr
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OWNER'S NAME Last �� Al,V�;7 First I � V17
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/Address
Owner's Address
Owner's E-mail
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City I V%`t ; -I k �— State I �H t
Zip Cl Telephone
APPLICANT'S NAME Last VJtit First Cprtir�t}J^
Applicant's Address
Applicant's E-mail Address
City 7 V4�t.i ✓(. State G
Zip Z- / (�� Telephone j �I( -5j� j p 4� (0
ARCHITECT/DESIGNER'S NAME Last
Firstr Lic. No.
L F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip F— Telephone
ENGINEER'S NAME Last
First I Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I State F—
Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY f) �r �`Y.�
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/ mac Lic. No. � jam Class
Contractor's Address
Contractor's E-mail Address
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Zip °�—�TelephonecitY
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 0 1 I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $