HomeMy WebLinkAboutX2021-1582 - Permit Application_----•a. vro,uv ouiming & soiar Permit Application a"`�'°^a
( COmm'I r Residential City of Newport Beach -Building Division e
NOTE:
_
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuildin 9 F_ Grading
(wp0.
`Drainage �Elec rMech f—plumCu Yd Cuc� j`
Cu Yd Fill
Project Address (Not Mailing address) r Flood Fire F-" Liq j` Landslide [N/A Floor
Suite No
ascription of Work
?:7+��v! iZL / v5�21V/V(�ajp [`77< .f Use Const Type
CZ�Z ! lLe
# Stories # Units (if Res)
New/Add SFF— --
-
Remodel SF( -- Valuation a
�- Garage/New/Add r"--.`— Material/Labor ��'
OWNER'S NAME
Last
—
h%Z. ,n� _ .._.. yl. M_
l�� � First dWM___ � s
OwneF's:Address
- - --
C
t l U Ss�;ti 7711 ,C—Z.cA-
Owner's E-mail Address
72- ,IQt,,z __ _ i
Clty C/JiLj
ceW
State �Ji- Zip q ZG �� 1
--" _ Telephone [/ice- ifs.. ��.��
APPLICANT'S NAME
Last
.First
Applicant's Address
-
Applicant's E-mail Address
City....
_.. State r.-_.._...-_., ZIP
r�. Telephoner._-_.__..._—.....
ARCHITECT/DESIGNER'S NAME
Last _-----
_... _ ..First
f Lic. No. F-.Architect/Designer's
Architect/Designer's Address
E-mail Address
City
State �.__._..- Zip
---�---- rTelephoner__..__-._,- _.
ENGINEER'S NAME
Last ��������
First I Lic. No.r--_.._.
Engineer's Address
Engineer's E-mail Address
City
State
zipTelephoner...__°..--__-
CONTRACTOR'S NAME/COMPANY
Lic No. �— Class
Contractor's Address
Contractor'sE-mail Address
City _ _
State w Zip
�� Telephonel_..._._..-..
BACKS REAR
[SETBACKS
SETBACKS FRONT PERMIT
LEFT
ZONE
SETBACKS RIGHT PLAN CHECK NO'
DEVELOPMENT NO PLAN CHECK FEES'$