HomeMy WebLinkAboutXR2022-3294 - Permit ApplicationF?rint Form_J Worksheet fOC
j- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building Grading
F—Drainage F_ Elec Mech F— Plum Cu Yd Cut Cu Yd Fill F v
Project Address (Not mailing address) F_ Flood (— Fire j` Liq F_ Landslide 1_N/A Floor Suite No
Description of Work
Use se Const Type
# Stories # Units (if Resf
Valuation $
Material/Labor
New/Add SF
Remodel SFs— Garage/New/Add
OWNER'S NAME
Last Po (U,� First
Owner's Address
Owner's E-mail Address
City e V PC) C- bpi✓, State Zip �f�G ( Telephone
APPLICANT'S NAME
Last Ct>� l i n S First _1�0 j
Applicant's Address
Applicant's E-mail Address
20104 SG,. I
r
City s e_ r r .' T0,�
State C Zip GI O `7 t: j Telephone
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
F7
Architect/Designer's E-mail Address
City
- ---- _
State �— Zip Telephone
ENGINEER'S NAME
Last First Lic. Nol
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephone
CONTRACTOR'S NAME/COMPANY
iilr`� �� Lic. No. �aa '. Class
bmn "_ ✓t e-fJ- �j"� I� �_�. �-
Contractor's Address
Contractor's E-mail Address
�0I0.q- 5_in�`�
{ .
City I c e r r t �05
State C � .. Zip � 0 % n Telephone
SETBACKS REAR
SETBACKS FRONT ` PERMIT NO. 2a�' �•
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. '•��i�1j,2 �311o�t
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $