HomeMy WebLinkAboutPV2022-0370 - Permit Application__ Print Form, _� W01i kshef,t or Combo OWUng 8, War Perri-ilit Appiicatio' n
F Comm'I F_ Residential City of Newport Beach - Building DivisionAIT
2 2s®NOTE: PLAN CHECK FEES DUE AT TIME OF SUBAL
F Building F_ Grading F 'Drainage j_ Elec r Mech Plum Cu`
u Yd CutF Cu Yd Fill
Project Address (Not mailing address) f_7 Flood f Fire �` Liq r Landslide f_N/A Floor
Description of Work
cr, i, G/ Z i Atic I S C7 • t j L �-v
� loci •�� � C� . � � � � !�t( 2
New/Add SF Remodel SFF_— Garage/New/Add F-7-
Suite No
F_
Use Const Type F
# StoriesF_ # Units (if Res)F7
Valuation $) �'��• "
Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City \...__ State . -- Zip 6 G Telephone
APPLICANT'S NAME Last
�-vc C-, First C C
Applicant's Address Applicant's E-mail Address
5____
--
cit
yF5_FJ__,)��`� ._.._.V�..1 State Zip _�J Telephone / c.
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address Arch itect/D esigner's E-mail Address
City State �— p F_! Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
_.._. _... . .
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY ) Lic. No. Class C
Contractor's Address
City, State C�—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip °1v�i Telephone -1)j
PERMIT NO.
PLAN CHECK
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $