HomeMy WebLinkAboutX2021-0023 - Permit Application (3)rm I'' " Workslieat for'Coiinbo'B'uilding` & Sblar'Permit 12gi icatioi
City of Newport Beach -Building Division
j Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
3uilding [Grading `Drainage VElec ?`Mech Plum Cu yd Cutl Cu Yd Fill
,project Address (Not mailing address) F_ Flood r Fire F- Liq F- Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type
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# Stories # Units (if Res)F
Valuation $
Material/Labor W _
New/Add SFF__ Remodel SFr_
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Garage/New/Addnn
OWNER'S NAME Last, t`ls
First
Owner's Address
Owner's E-mail Address
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City e State
Zip ILLI -- Telephone � ��7J
APPLICANT'S NAME Last l
First
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
First f -- - -- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City State r--
Zip �-.---- Telephone(---------
ENGINEER'S NAME Last
I First f ` n LIC9N0.
Engineer's Address
Engineer's E-mail Address f ', T 1W
City State
Zip F TelephoneF��
CONTRACTORS NAME/COMPANY Lic. No. ��bd Clas
6c :I -ees �t4_ 5 3
Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. - 0-0
SETBACKS LEFT SETBACKS RIGHT
V#VWUPLAN CHECK N0.
USE ZONE DEVELOPMENT NO
" PLAN CHECK FEES $