HomeMy WebLinkAboutX2021-2710 - Permit ApplicationComm'I Cit of New
� esideritial Y port Beach -Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building (— Grading F -Drainage F— Elec F Mechf
F -Plum Cu Yd Cut Cu Yd Filll
Project Address (Not mailing address) ( Flood j— Firer Liq Landslide (-N/A
Floor Suite No
Description of ork
Use Const Type
ac Co r w
# Stories # Units (if Res)[
New/Add SFF— Remodel SF — Valuation$
Garage/New/Add �—; MateFial/Labor,
OWNER'S NAME Last
�aori/I9% First % 'C Q�
Owner's Address - / - -- -
Owner's E-mail Address
City N,.eta/- ®. State �— Z _.. .__
P �- Telephone—
APPLICANT'S NAME Last
First
Applicant's. Address __ ...
Applicant's E-mail Address
city
State �— Zip F Telephoner
ARCHITECT/DESIGNER'S NAME
Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ zip Telephoned
ENGINEER'S NAME Last
_.. First Lic..No.
Engineer's Address Engineer's E-mail Address
City State F_.— Zip I ---------------- Telephoned
CONTRACTOR'S NAME/COMPANY t 0r�. N� g hs
Contractors Address Contractor's. E-mail Address
City _...... _. State F Zip F TelephoheF—... ___...
I
SETBACKS REAR SETBACKS FRONT PERMIT NO. fsJ -1111
SETBACKS
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO:
�V 8
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ i