HomeMy WebLinkAboutX2021-0999 - Permit Application (4)...._. .....
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r Comm'l fXResidential City of Newport Beach - Building Division X
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTTAL�4l
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Description of Work
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t,; I ,_ # Stories # Units (if Resf _
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OWNER'S NAME �g�
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Owner's Address Last First
Owner's E-mail Address
State Zip
Telephone
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APPLICANT'S NAME g,qy
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Applicant's Address - - _ First A IZS
Applicant's E-mail Address
city r — _ I Telephone---
State r-'— —
ARCHITECT/DESIGNER'S NAME Zip
Last i
Architect/Designer's Address - First Lic. No. r—
Architect/Designer's E-mail Address
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City State r_-- Zip (�"— TelephoneF`.---
ENGINEER'S NAME s f h
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Engineer's Address Lic. No.
- � ( Engineer's E-mail Address
city '�..� lsl State Zip `%2✓�, 0 Telephone '3(G t{3
CONTRACTOR'S NAME/COMPANY
t CC q.t ,yj q p Lic. No. C1
Contractor's Address / C �' S�i L �.. i-��S�sSa;'y' ���/t5i Class
ohtractor's mail
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_ State Zip G .2 Telephone e( f9
SETBACKS REAR —_ SETBACKS FRONT
SETBACKS LEFTPERMITNO _�(�)� I
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�_ SETBACKS RIGHT // I
USE ZONE PLAN CHECK NO, _Qq
DEVELOPMENT NO PLAN CHECK FEES $--"I