HomeMy WebLinkAboutXR2023-0782 - Permit ApplicationPrint Form Worksheet for Combo mbo Building
F- comm'I Port Beach
Permit A I— Residential City of New pplioation F+EWPpaT
h - BBuilding Division NOTE: PLAN CHECK FEES DUE A TIME OF SUBMITTAL oP
Building Grading F-Drainage F Elec
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Project Address (Not mailing address) C Flood F- Fire covdcut i cuYdFill
` 08 F Liq F- Landslide FN/A
�.tveR ��Y� Floor Suite No
_ _ --- NEW Description of Work C(Z6C 3 F— F—
toot fSKri owL j i vn� 7dj2FM01;>eL Use Ri�;_ Const Type f/(/
# Stories #Units (if Res)
New/AddSFF �
Remodel SF�— Garage/New/Add Valuation S
OWNER'S NAME Material/Labor
Last � -
�Pl..l�(Sf=uM t -... -..
Owner's Address First Molza, e
Owner'sE-mailAddress -
City - 6,AFFLtc)408 �� a tic. co✓I ��^lt_o�"ZT- (; C'Ar_F+ State _.. -
CA _ Zip q Z663 Telephone APPLICANT'S NAME 40 `I 3 Z Z -(, gQ z
Last (AzgASNt_ -
Applicant's Address _ _ First CAN D y
SS(S C _ C-A Pn UA Applicant's E-mail Address
City CGA(z,gA:3 3 tLe �Rn/ ANaN�tr 1 State � CA g)U�iS ,C) �J
I t� Zi
ARCHITECT/DESIGNER'S NAME p IZSv� Telephone -llH_ 651-1-77_7
Last
Architect/Designer'sAddress - FirstLic. No.
Architect/Designer's E-mail Address
city
State -
Zip Telephone��
ENGINEER'S NAME
Last
Engineer's Address First Lic. No.[ --
Engineer's E-mail Address '
I
city
State Zip
Telephone��
CONTRACTOR'S NAME/COMPANY
Contractor's Address Lic. No. Class
Contractor's E-mail Address
City
State F — Zip
SETBACKS REAR SETBACK
SETBACKS LEFT
FRONT
USE ZONE SETBACKS RIGHT
DEVELOPMENT NO
Telephone®
PERMIT NO.
PLAN CHECK NO,
PLAN CHECK FFFc x