HomeMy WebLinkAboutXR2022-3033 - Permit Application�_ print Form I WOrksheet for Combo Ba, flding 81 Sola ° Vlermut Applicat'do n
Comm'I PResidential City of Newport Beach - Building Division 21- ',u bs
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j— Grading [—Drainage F Elec F- Mech F- Plum Cu Yd cutl Cu Yd Fill F—
Project Address (Not mailing address) C- Flood F- Fire j7 Liq F- Landslide F-N/A Floor
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Description of Work p4J,4;r�/'t h-,14A6 R-47§ 1- el-A7704
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New/Add SF Remodel SF �t Sf Garage/New/Add �—
OWNER'S NAME Last` "
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-- � _._..__../�/�N�.=- �"� First
Owner's Address
City
APPLICANT'S NAME
Own
Suite No
Use /��ConstType T-/�
# Stories 7 # Units (if Res
Valuation $
Material/Labor
State
_....._ ._ Zip Telephone
Last
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Applicant's Address - ----- ._...__.__._.._.._____.
Applicants E-mail Address
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city
NG-/3bf State 7Zip `�Z 4�(vL p one G
ARCHITECT/DESIGNER'S NAME Last ��
First 0'Z.A Lic. No. -- Z- ' 2 2c
Architect/Designer's Address Architect/Designer's E-mail Address
City - - _-- - "'� -6rtat _ _ Zip Telephoned
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State 77 ZipF— Telephone—
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CONTRACTOR'S NAME/COMPANY
.X ?'1 /� .� Lic. No. 56.Al.� Class iT _
Contractor's Address Contractor's E-mail Address
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City . 6�}r7q YO-P, State
zip a6 Telep hone z 710
SETBACKS REAR SETBACKS FRONT PERMIT NO. V Zy??_ 3033
SETBACKS LEFT SETBACKS RIGHT _ PLAN CHECK NO. PZ®22..1 Ceftk