HomeMy WebLinkAboutX2021-0565 - Permit Application' Prini Form Worksffor Cdinbo Baifdirtg & Solar Permit Application fRr
r Comm'I residential , City of Newport Beach - Building Division /
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL+�
\$CI)ilding j— Grading rainage �6ec Nlech Plum CuvdCut cuvdFill ._-9
Project Address (Not mailing address) F_ Flood F_ Fire r Liq F_ Landslide A Floor Suite No
31 9 61crsw S �—
Description of Work Use ConstTyp�"°
�C ) S r w k—T--,4 # Stories # Units (if R
d=6Z, i--DC>C^ kp Z>:�, i
tkI Valuation $ 2
New/Add SF �r � % Remodel SF Garage/New/Add Material/Labor 91ci
OWNER'S NAME Last :ac (u1 )!�,zc U `J�
Owner's Address �� ( C Nt�L-SCox �c .��c��J"c Owner's E-mail Address"
PL-t. N j�N c. Ntc;VA-C," t�jcdrrp)0*j (f-s Cal
City �'E�Ai�' Qc� State C_),Z Zip I Telephonel
APPLICANT'S NAME Last l C—,LiQ!Ez;
Applicant's Address
City �L 'y i State I CQ
First �� L
Applicant's E-mail Address
Zip Telephone � t4— K(0 S- Lk / �
ARCHITECT/DESIGNER'S NAME Last First
T� Bo Lic. No.Z
Architect/Designer's Address Architect/Designees E-mail Address
�� r:;Z � �7�� f�c"IT�t�€ , Corn
City �,p � �S�p State G7O Zip Telephone qk_n—105�1�3
ENGINEER'S NAME Last First iFi� (,:�—t Lic. No.IC
Engineer's Address Engineer's E-mail Address
City I Zv. VjC State I C� Zip Telephone 3J � 5 3/
k
CONTRACTOR'S NAME/COMPANY
\
C'
CC> Lic. No.Class
Contractor's Address
Contractor's E-mail Address
"C
(
City v �C �
State I ` rV
Zip I Q Telephone I
S I
ISaD7 2
,1
SETBACKS REAR j � SETBACKS FRONT
' PERMIT NO. �"Ck
SETBACKS LEFT_ SETBACKS
RIGHT
/ PLAN CHECK N .
�7
USE ZONE DEVELOPMENT NO GL.1 . C)W J PLAN CHECK FEES $l4;•