HomeMy WebLinkAboutX2020-2252 - Permit Application (2)' �rlt;f Fbrfn`'"Worksheet for Combo Building"&`Bahr° P6'rm' .it A' plicat'iar
o091111 Comm'I F Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMaa"
F—Building rGrading rDrainage j-Elec rMech
[Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F_ Fire F_ Liq r Landslide r_N/A Floor Suite No
D - (--gym S(p - -
Cv f
Description of Work
Use F Const Type
# Stories # Units (if Res)[
r ,
v v V I
I/M�N
!^ /
New/Add SF Remodel SF F_ Garage/New/Add (------,
Valuation $
Material/Labor
OWNER'S NAME Last First
Owner's Address 01V el jF '
Owner's E-mail Address
City I � State ---
Zip r__._- Telephone_—..._--..
APPLICANT'S NAME Last First (!�W
Applicant's Address
Applicant's E-mail Address
City State I—
Zip /, Telephone %t 10 —7730
V
ARCHITECT/DESIGNER'S NAME Last --
First I Lic. No. F--------..-.—
Architect/Designees Address
Architect/Designees E-mail Address
City - State F_
ZipFTelephone___.—.-..--
ENGINEER'S NAME Last
First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State
Zip F-......__ TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic. No. 3aS?-9 Class
-7
q
Contractor's Address
Contractor's E-mail Address 15-C 3uo 77, 4
&
City State F.--
Zip f _--- Telephone -
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. '
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $