HomeMy WebLinkAboutX2017-2093 - Permit ApplicationIH65 20(7
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Comm'I Residential
City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT, TIME OF SUBMITTAL .�
Building r Grading
ainage I*Iec l i—Meth Plum cu Yd cut Cu Yd Fill
Project Address (Not mailing address) Flood F_ Fire r- Liq F- Landslide - N/A Floor Suite No `
Description of Work
Use At Const Type IY►J
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Valuation $
Material/Labor
New/Add SFF D
Remodel SF cd Garage/New/Add F
OWNER'S NAME
Last /t tri / First �iNA gsj VAA*f
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Owner's Address
Owner's E-mail Address I r IA i
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City�g�•{ I'
State Zip g z1r57 Telephone— '.
APPLICANT'S NAME '
Last First
Applicant's Address
Applicant's E-mail Address
City
State F Zip F Telephoner
ARCHITECT/DESIGNER`S NAME Last - FirstLic. No. tt. Z_
ArchitectlDesigner's.AddressQ
- ArchitecNDesigner's E-mail Address
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City Z;v J+t rlebrn
State Zip �]L!2% Telephone �t� a-75 61&3
ENGINEER'S`NAME
Last First "�(.ujt r� Lic.No.�
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'Engineer's Address
Engineers E-mail Address
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•Citlr F
State Zip �ZEO ii Telephone gLtq - qqq - 077&-r
CONTRACTOR'S NAME/COMPANY Lic.'No. F Class
' Contractor's Address -
Contractor's E-mailAddress
-City I
State ZIP Telephoner
SETBACKS FRONT PERMIT NO:
SETBACKS REAR
SETBACKSLEFT
SETBACKS RIGHT PLAN CHECK NO.