HomeMy WebLinkAboutX2021-2292 - Permit Application (3)Comm'I
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Residential City of Newport Beach - Building Division- -1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FX -Building [X Grading FX -Drainage FX flet
Project Address (Not mailing addrpc
Description of Work
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Suite No,
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INew/Add SFI— - Remodel SFF-- V luation $
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OWNER'S NAME Last /i
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Owner's Address �}
Owner's E-mail Address
City 3 r— State
1 I Zip Telephone
APPLICANT'S NAME Last
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.Applicant's Address
Applicant's E-mail Address
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City State
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ARCHITECT/DESIGNER'S NAME
Last -.- ..First
Lic. No. �--�-
Architect/Designer sAddress Architect/Designees E-mail Address
City State F_ Zip r---- Telephoner-- —
ENGINEER'S NAME Last
First Lic. No.F—_--._
Engineer's Address Engineer's E-mail Address
City StateZip r---- Telephoner-------
CONTRACTOR'S NAME/COMPANY I
L Lic. No.{vj SS Class
Contractor's Address - Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRON 3 y�
EI IT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. f
USE DEVELOPMENT NO .t6� ? .
PLAN CHECK FEES $