HomeMy WebLinkAboutX2021-2789 - Permit Applicationmint corm 1 worl(sneet Tor uornoo tsuming do zz�Olar verntlt Application of m
F_ Comm'I f— Residential City of Newport Beach - Building Division���
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j6Building F_Grading l Drainage [Elec f—MechrPlum Cu YdCut� CuvdFill
Project Address (Not mailing address) I-- Flood F-, Fire r Liq j— LanLLLdslide FN/A Floor Suite No
W��� �e n F_ F
_Pl
✓�
Description of Work
Use F—Const Type
ft
Man ' i /� �., t�ju7�✓�f
# StoriesF7# Units (if Res)F_
-
Valuation $
Material/Labo �j /' Ode
New/Add SFF— Remodel SFF Garage/New/Add
OWNER'S NAME Last t C t First
Owner's Address Owner's E-mail Address
(G fir,z �. �•/z
City �u�n,ji �`�L,�� State �/� ZipF7777— Telephone—
F- -
APPLICANT'SNAME Lastc, First
Applicant's Address Applicant's E-mail Address
City J -.ri.rGi?4 State /j Zip ! %G Telephone
F_- Lic. No. �—
ARCHITECT/DESIGNER'S NAME Last ( First
Architect/Designees Address Architect/Designer's E-mail Address
-.
City State I— Zip r Telephoner
ENGINEER'S NAME Last First Lic. No.F—-
Engineer's Address Engineer's E-mail Address
City State Zip I Telephone—
CONTRACTOR'S NAME/COMPANY��ff Lic. No. Class��
I'V 1�_C/ ! c4V e Cs u
Contractor's Address Contractor's E-mail Address
�( V"Vrf��.�% -7e
-
<< // A
City J'calr7�_ 7/� State C r Zip Telephone 1/6(,? `yc, 1_K175,
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO % Oi % I PLAN CHECK FEES $