HomeMy WebLinkAboutX2021-1935 - Permit ApplicationPrint Form W rKspeet for %.oiuuu uuuueny cs .aVIWb . num r.r r.....w....• B e
/ City of Newport Beach - Building Division
r Comm'I F- Resident) /.,„Tr. of nni rwrry FFFR nl IF AT TIME OF SUBMITTAL
�nBuilding [ Grading !Drainage )'Z,,Elec XMech .Plum CuvdCut Cu Yd Fill
Project Address (Not mailing address) I® Flood f—, Fire F-Liq r landslide,,,N/AFloor Suite No
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Description of Work Use` ConstTypeo
P -T 4-4 G I_Ci_> s7la `f
# Stories #Units (if Res)r—
y�.c7'TD
aluation
New/Add SFr Remodel SF �� Garage/New/Add Material/Labor' ,
OWNER'SNAME Last AC- e First
Owner's Address Owner's E-mail Address
city i�� p� State � Zip � 0 Telephone�J C, 1z)( 22�
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APPLICANT'S NAME Last ��L�, First yn.
Applicant's Address Applicant's E-mail Address
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ARCHITECTState �— Zip �'2( j Telephone 2 �J�i�-s-v�
)/DESIGNER'S NAME Last Firstj�}'11� 1c>—m tic. No. '�t�C �f
Architect/Designer's Address Architect/Designees E-mail Address
CityF)-)) S 7 State C; Zip tl2G-1 � Telephone F4�
ENGINEER'S NAME Last F I First Lic. No.F—
Engineer's Address Engineer's E-mail Address
city State F Zip F-- Telephone-
CONTRACTOR'S NAME/COMPANY Lic. No.__11Gj Class_
Contractors Address. Contractor's E-mail Address
City l� 11 a �i� t� 0 State f ¢S Zip ] TelephoneF9,4 15 � je-� iq
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SETBACKS REAR SETBACKS FRONT PERMIT NO. i 1 01d_
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Iv "4�'#
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $