HomeMy WebLinkAboutPV2022-0329 - Permit ApplicationPrint Form Worksheet for Combo Building & Soler Perm'
_. .Comm'[ K' Residential City of ►Yew Z Plication
port Beach - Building Division �/v �,�) /� Y
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL O �' !
Building Grade( FEES
EEe J
�-`it!iee1A �W" Plum ��5rd�esi
Project Address (Not mailing address] T- Flood {- Fire 1 Cu Yd Fill
-y,�/ r Liq l— Landslide rN1A Floor
Suite No
Descriptiion of Work
'e c o 14 0 Berl �,f 3D EY�cc Use � Const Type FqC [�
�7) 6iinhaSe- _ s] `--
`" _ . �l �L LQ #Storie
# Units (if Res)I(
ram'
New/Add SF Remodel SF�"-""--
Garage/New/Add I Valuation $
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Material/Labor
OWNER's NAME L �A
Last Y"l
Owners Address First
Al. G meters E-MA Adftw
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City N/� / -1 �-Z��_ State
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Tefephone1_ APPUCANrS NAME
Last
/v Firsts
Applicant's Address
Applicant's E-mail Address
city
�'✓I Yj ad State / C c_'�, 1
e, Zip Telephone
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designers Address First-Lic. No. I
ArchitecUDesigner's E-mail Address
City
_ State � Zip Telephon�.
e
ENGINEER'S NAME
Last
First �����`
Engineer's Address Lic. No.
Engineer's E-mail Address
City
State F_ Zip
J Telephone
CONTRACTOR'S NAME►CQW p HY
Contractor's Address ' tK' NO' L U ' �' Class C I
Contracles E-mail Add
city
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Zip TelephoneFqo/p
SETBACKS REAR SETBACKS FRONT -
SETBACKS LEFT PERIW RIO. w �Z Z _ d
SETBACKS RIGHT
USE ZONE PLAN CHECK NO. ��L�
DEVELOPMENT NO PLAN CHECK FEES $ Z(