HomeMy WebLinkAboutX2021-2292 - Permit ApplicationjX Buildi-
�¢y of Newport Beach- Building Division rr^va"vo r
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL s�
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;ription of Work
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TX_ Mach (X plum Cu Yd Cut - -
Cu Yd Fill
Fx Floodr" Fire FX Liq FX Landslide Fx`N/A
Floor Suite No
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Use F_ Const Type r
/ 9 1 # Storiesi # Units (if Res)r—
New/Add SFr___.__-._
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OWNER'S NAME t
Last 1
Owner's Address "� First
Owner's E-mail Address
City CCLt'o
State �— 61st � Cv"' ueZ
Zip Telephoner ----- --
APPLICANT'S NAME
Last
Applicant's Address - First
Applicant's E-mail Address
City Jr� -�
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l Zip l Phone
Tele ,,, ,..,
ARCHITECT/DESIGNER'S NAMES 3 --->
Last `i �' 1
Architect/Designer's Address First r ' —---
Lic. No.
Architect/Designer's E-mail Address
City
_ State Zip
ENGINEER'S NAME NAME
Last
Engineer's Address - - First
Lic. No.F�
Engineer's E-mail Address
Cityo
State=e®® Zips
Telephone_—
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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Cit
y.� State r-
Zrp>t Telephone
SETBACKS REAR SETBACKS FRON I
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SETBACKS LEFT �_ E IT NO
SETBACKS RIGHT
JSE ZONE PLAN CHECK NO
DEVELOPMENT NO t�=
PLAN CHECK FFF.R It J