HomeMy WebLinkAboutPV2021-174 - Permit Application_- ••• ._I 1111V1 n�uvcc IV® a V® IN UU DUIIU I I II,. of JVlcli r'!.rnilL iAli Ilcation Od
RmF_ Comm'I r Residential City of Newport Beach - Building Division �IzJU
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ," ..�
Building Grading Drainage [ Elec j-Mech Plum CuvdC tF Cu Yd Fill l
IIII -'
Project Address (Not mailing address) L- Flood r Fire r— Liq [— Landslide F_N/A Floor Suite No
Description of Work Use�', Const Type—!
# StoriesF # Units (if Res)F-
- — -- - — — - -- --- —
Valuation $
New/Add SF� Remodel SF�— Garage/New/Add Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
--- - - _- -- --
city �- State �— Zip Telephoner
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State �— Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First �—
Lic. No. Architect/Designer's Address _Architect/Designees E-mail Address
City State �— Zip F Telephoner
ENGINEER'S NAME Last F First Lic. No:F—
Engineer's Address Engineer's E-mail Address
........ -
city State 77 ZIP Telephoned
EONTRACTOR'S NAMEXOMPANY /� An � ' (� t , Lic. No. �- Class F_
Contractor's Address t l Contractor's jE-mail Address
Wevd VAI,
city w�� State ( Zip I Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q-1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $