HomeMy WebLinkAboutM2022-0052 - Permit ApplicationI�rintForm_� Bel®a ksheet for Combo BuildingSo@al Permit Application (la-A
F_Comm'I r- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building F_ Grading F-Drainage FElec I—Mech F Plum cuYdCut F_ cuYdFill
Project Address (Not mailing address) F7 Flood F_ Fire r Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use ConstType
1
# Storie # Units (i es
Valuati $ C Q
Material abor d 5 r
New/Add SFF -- Remodel SF�- Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State-- Zip I Telephone
APPLICANT'S NAME /
Last l �r Firsto1i le>
Applicant's Address Applicants E-mail Address
�Y"^ .j!a.
/�_
City N�V 6, (1r �jtG L y State (, Zip q rCC 0 . Telephone / �iyj {y 3�j
ARCHITECT/DESIGNER'S NAME Last F First —Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State I Zip �— Telephoned--
...... ........
ENIGINEER'SNAME ' --
Last `7t. wl(,i11�- -_ _..... First `W t ` I CAI,) Lic. No.F
Engineer's Address Engineer's E-mail Address
C�Gf(11
City �U�\� ' (t�� t State C l� ZiP II &}j �U' G'IL� 1 Telephone CE; - +C
CONTRACTOR'S NAME/COMPANY �ILic. No.Class C�
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Contractor's Address Contractor's E-mail Address
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City - State �t Zip Z. c_ Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. l c `' ` _
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $