HomeMy WebLinkAboutX2020-2222 - Permit Applicationf Print Form Worksheet for Combo Building & Sr iar Permit Application o4 EW�q@
Comm'I r Residential City of Newport Beach - Budd;:i,q Division
NOTE: PLAN CHECK FEES DUE AT T RAE OF SUBMITTAL
( Building F—Grading [—Drainage F_Elec (—Meth 7Plt_,l Cu Yd cut �. Cu Yd Fill
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Project Address (Not mailing address) Flood I- i— Liq F Landslide F_N/A Floor Suite No
1515 Signal
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Description of Work
Use R-3/U Contt Type IvB
emolition of existing 2-story single family residence w/4 bedrooi:ls & 4 bathroom4 s s. 329f. ,.
# Stories[ # Units (if Resf I
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New/AddSFI RemodelSFF
Valuation $ 15,000
garage/New/F,dd ''. Material/Labor
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OWNER'S NAME Last nderson v
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Owners Address
Owir�r's F_-mail Address
1515 Signal
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City Newport State Beach CA
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Zip i92661 Telephone 949-975-0123
APPLICANT'S NAME Last Teale
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First P.`ark
Applicant's Address
Applicant's L-niaii Address
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�2900 Bristol Bldg A-203
mtealeVte:;iearchitecture.com
City Costa Mesa State
,; 2F Telephone 49-975-0123
ARCHITECT/DESIGNER'S NAME Last iTeale
_ First Mark Lit No. C-22162
Architect/Designer's Address
Architect/Designees E-mail Address
see above
City State I
'n TelephoneF
ENGINEER'S NAME Last ------_--
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Fits[ ; Lit No.F
Engineer's Address
Engine: =s E-mail Address
City j State �
Zip ( Telephoner
CONTRACTOR'S NAME/COMPANY ' �C ,/Lit No. �3 7lassj �N
Contractor's Address UUU
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11 Contractor'- F-mai] Address
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City State 1 �
Zip Telephone 7 ( %,� 7S7
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $