HomeMy WebLinkAboutX2021-0025 - Permit ApplicationPrint Form j Worksheet for C bo`Building & Solar Permit Application of"` '°"a
F Comm'I j,'Resi tia N w
, ` �� f port Beach - Building Division q
` CK FEES DUE AT TIME OF SUBMITTAL
,K`Building j- Grading F-Drainage F_ Elec F Mech r Plum CuYdCut CuvdFill
Project Address (Not mailing address) F Flood F_ Fire r Liq (" Landslide FN/A Floor Suite No
Description of Work =1
Use F— Const Type
T
1'I
# StoriesF_ # Units (if Res)7
Valuation $ r-
Material/Labor � J
New/Add SF��
Remodel SFF_
Garage/New/Add ��
OWNER'S NAME Last S L D
First L�/
Owner's Address
Owner's E-mail Address
City N State
Zip �e4? Telephone 317. `13 i �f 2,7
APPLICANT'S NAME Last r— I I rY
First 1
Applicant's Address
�2
Applicant's I mail Addle
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ma`s �'an
City State
I�/J�W'ynV� �IQ(�/�
aloe s. cam.
Zip F—q Telephone % y . A q Ki y
ARCHITECT/DESIGNER'S NAME Last F_/
First F_ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City F� State F—
Zip [_ Telephone[
ENGINEER'S NAME Last �++rl !*^�
First ... Lic No.�
f Engineer's Address
Engineer's E-mail Address
I
City State
Zip �— TelephoneF
CONTRACTOR'S NAME/COMPANY O
Lic. No. u 0 7 S Class(
LContractor's Address
Contractor's E-mail SAddress LL/"
City� State
' G�l"((fG �yU
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. pAP
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES ♦ C) �" J