HomeMy WebLinkAboutX2021-3053 - Permit Application (3)Comm'I Residential City of Newport Beach =Budding Division { j 001"
NOTE: PLAN CHECK FEES DUEATTIME OF SUBMITTAL_
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Description of Work
Use Const Type
# StorfesF�, # Units (if Res)
New/Add SF�— Remodel SFF Valuation a -y
__ Garage/New/Add �— Material/Labor- (j
OWNER'S NAME Last��//
I�'� l"pl{- First
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:Owner's Address
71,77 grOwner's E-mail Address
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City ^/wi_ State— q
- Zip L 'S Telephone qq%% j&
APPLICANT'S NAME Last 4y
First
Applicant's Address - -
Applicant's E-mail Address
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City r" k fVOk- State- Zip g2�' Telephone
ARCHITECT/DESIGNER'S NAME
Last First
Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City Zip State �— �— Telephone
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ENGINEER'S NAME Last 1a
FirstC70W-2 Lic. No.
Engineer's Address Engineer's E-mail Address ^
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city tlGFil�Y� State I q � — F 1.42
ZiP 419 Telephone—
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CONTRACTOR'S NAME/COMPANY G , -7�"J� �—
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Contractor's Address Contractor's E-mail Address
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State �- Zip q Telephone cJq
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SETBACKS REAR SETBACKS FRONT z
P MIT NO. Nl�✓� — �(j��,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0 Q-2
USE ZONE DEVELOPMENT NO a - PLAN CHECK FEES $