HomeMy WebLinkAboutXR2022-3185 - Permit ApplicationI Print Form I Worksheet for Comb® d uflWng & War Permit Application
F_ Comm'I Residential City of Newport Beach -Building Division X (Z2®2,2 — 3 I � J
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—Building f`' Grading ' ?,;Drainage I Elec (" Mech
Project Address (Not mailing address) f Flood
Description of Work
?PL--- IV�
s co 1,5-) ,
(� Plum Cu Yd Cut Cu Yd Fill
f— Fire [_ Liq r Landslide
New/Add SF Remodel SF I— Garage/New/Add I
FN/A Floor
r
Suite No
F_
Use F— Const Type
# StoriesF_ # Units (if Res)F_
Valuation $
Material/Labor
OWNER'S NAME Last First�ej
Owner's Address
City ® r Y
State
APPLICANT'S NAME Lastre
Applicant's Address
1,61q /&_771
city j/ "o_ State Cif-t--
Owner's E-mail Address
Zip
19
First
Applicant's E-mail Address
Zip , ,� -*Telephone 27 ' h,
ARCHITECT/DESIGNER'S NAME , Last First
Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City I State I Zip Telephone r
ENGINEER'S NAME Last First [j0,q,,jzy Lic. No.
Engineer's Address
City /37� State „
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Engineer's E-mail Address
Zip I ' '"'7 ' Telephone 7 tf Z
Lic. No. Class
Contractor's E-mail Address
Zip Telephone
PERMIT NO.
r
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $