HomeMy WebLinkAboutPC2022-2773 - Permit ApplicationPrint Form I Worksheet for Combo BujUng & Suiar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division 22. - -2-7
73
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F,'Building F_ Grading [-Drainage r- Elec F7 Mech Plum Cu Yd CutF — Cu Yd Fill
Project Address 1Nn# mailing gmrjqjz-e F_ Flood 1:1 A r-KI/A
r- 0.71 FI1-1 [ Landslide Floor Suite No
F_
Description of Work
New/Add SF Remodel SF Garage/New/Add
. .......... ..
Use F Const Type F
# Stories[ # Units (if Res)F
Valuation $
Material/La�F&W)o
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
city State
Telephone --c
APPLICANT'S NAME Last First I c�.5
Applicant's Address Applicant's E-mail Address
... .......... . . ... .... . ... .. .....
1--_ I—— 1. -.1.1- � ..... .... - ----------------- --- ---
city u,'* State zip Telephone
ARCHITECT/DESIGNER'S NAME
Last ....... .. . . . .... .... .. ... First Lic. No. F_-
Architect/Designer's Address Architect/Designer's E-mail Address
.. . .......... ...... .. ...... .. ..... ... . ....... . ......
city State Zip Telephone
ENGINEER'S NAME Last First F_ Lic. No.
Engineer's Address Engineer's E-mail Address
.............
City State Zip Telephone F
CONTRACTOR'S NAME/COMPANY Lic. No. — Class
Rj s 2 ai
Contractor's Address Contractor's E-mail Address
City DO, lVv- State F Zip Telephone 1q,4_
G7 Z_
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
PERMIT NO. YJZ;ZZ_L-Z — ZOIC
PLAN CHECK NO. VCZC5&& - -L-?
DEVELOPMENT NO P7'S —c) 6 Z-t PLAN CHECK FEES $
SETBACKS RIGHT