HomeMy WebLinkAboutPV2023-0067 - Permit ApplicationL trintForm Wr rlksW?t for Combo Building & Sonar Permit Appkation 6 °°a>
j— Comm'I F Residential City of Newport Beach - Building Division p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL d� c.
r—Building [ Grading F-Drainage F_Elec Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) (- Flood (- Fire f— Liq r Landslide I —N/A Floor Suite No
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Description of Work
42 (� l��
Use r ConstType
# StorlesF_ #Units (if Res)
Valuation $
Material/Labor
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New/Add SFF -- Remodel SF� Garage/New/Add �-
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OWNER'S NAME Last B y Iiq; d First Je f�
Owner's Address Owner's E-mail Address
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City P7t w e r' f C 0 g S} State �,' i Zip 3 b _ Tele hone---�
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APPLICANT'S NAME Last[ c o K t 7,15 ,15 First er
Applicant's Address Applicant's E-mail Address
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y �4 4 n 9 K C' h State C/ Zip^
city .. __ P 7L� 5 Telephone �Zi L 1 y 975
ARCHITECT/DESIGNER'S NAME Last First F_Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State r.-- Zip Telephoner
ENGINEER'S NAME Last First F Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State Zip Telephone F—
CONTRACTOR'S NAME/COMPANY An i L P S N / Lic No. IT S33 Class L_"
Contractor's Address Contractor's E-mail Address
City L g 9 u A; 1 2 q, (k State L Zip 92 E}/ Telephone ($u $ S S 4 -4Sr r
SETBACKS REAR SETBACKS FRONT PERMIT NO. vf
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. CZ7 " �Q
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USE ZONE DEVELOPMENT NO QZuZZ - 0 i?y Z PLAN CHECK FEES $