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HomeMy WebLinkAboutM2021-0016 - Permit ApplicationWorksheet for Combo Building a lw'° . • - ° _ print Form City of Newport Beach- Building Division M2D 'WQ�U G4[oaM'P Residential NOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Cu yd Fill Comm'I Plum CuvdCut r X Elec rX Mech � Sooruite No Grading jXDrainage (� Landslide rN/A FII ix—Building r (X Flood jX Fire Llq r Not mailing address) �a! project Address ( /� , > 17 1jS fLt�` �PJfbitLLi r ConstType User of Work #Stories # Units (if Res)F Description 7 fD - Valuation $'`y ®Lj 00 Garage/New/Add e/New/Add Material/Labor r------- New/Add SF Remodel SF �_------_ First OWNER'SNAME Last - Owner's E-mail Address Owner's Address R �a ",&)( ys®r) l cne r Telephoner--- State F Zip City First �l7L �fll� fi� APPLICANT'S NAME Last Applicant's E-mail Address ` PP Applicants Address �Q �� � R '1 % � - Telephone 1 O S � 0�" — State CA Zip q j��i City 070 �TC9 _ Firstr---- LIC. No.- ARCHITECTIOESIGNER SHAME Last ArchitecUDesigner's E-mail Address Architect/Designer's Address 5 State �___.9 Telephoner ---- _ _._. Zip CityFirst �.��®�� Lic. No. �" 3 10 _ _ ,�! ENGINEER'S NAME Last '� � P j4 ,Z_l Engineer's E-mail Address ,� tt� 5�1� CO w, - Engineer's Address n C20 �t,,a r; j (��� ©�'ir7�Cd26Telephone qq l/C' ZiP'9J(J ^P'_ �¢j[(L`✓! State c No. Classr city d�G ! ( L Cf.Cf $ZC � iudh CONTRACTOR'S NAME/COMPANY r7lr� C Contractor's E-mail Address r (�CeSyaGrCtd4C CwL' Contractor's Address A PI� (L1 D- Ad� Telephone D cl 1 7 `! State C i Zip 93 [ City r to PERMIT NO. SETBACKS FRONT ------- PLAN CHECK NO. SETBACKS REAR ------- _— SETBACKS RIGHT PLAN CHECKFEES $ �-- SETBACKS LEFT �— DEVELOPMENT NO USE ZONE