HomeMy WebLinkAboutXC2022-2107 - Permit ApplicationPrint Form Worksheet for Combo Buiidin
�omm'I r Residential City of Newport Beach- gDivision ildinng olar Permit Application
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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9 I- Grading j`DrainageEleC
Mech F Plum �
Project Address jcard c�c� Cu Yd Fill F_
i�(N�ot mailing address) F Flood F Fire (- Liq r Landslide FN/A Floor
cNG Suite No
Description of Work
Use j _ Const Type
-- #Stories # Units (if Res)r—
New/Add SFF— -
Remodel SF t�LI- �-� Valuation $
J i L 7 Garage/New/Add
Material/Labor
OWNER'S NAME
Last .��'1 �
Owner's Address First
1 1 Owner's E-mail Address
City-,—
_i'fi �17i t1 State T—
Zip
1(�Z Telephone/ --
APPLICANT'S NAME Last Z
- ----
Applicant's Address i First
Applicant's E-mail Address
n5 -'
. �� ��. State —
City
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u 4_
Zip Telephone 'Za
ARCHITEC�/tSESIcmERy�AME
Last aaq /� +
Architect/Designer's Address vl First
VVV Lic. No.
Architect/Designer's E-mail Address
City r - -
- State I —
Z-
—
ENGINEER'S NAME
Last zip � Telephone[
Engineer's Address First Lic No.�
Engineer's E-mail Address
City
State ZIP
Telephone
CONTRACTOR'SNAME/COMPANY �I
Contractor's Address � Lic. No. m, rynh Class
']1 Y Contractor's E-mail Address
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City �,
State ZIP L.4ti1
1 �� O Telephone /q,rs�j Z� C,
SETBACKS REAR SETBACKS FRONT " �
SETBACKS LEFT
— PERMIT N0. G`
USE ZONE
— SETBACKS RIGHT —
PLAN CHECK N0. C`2o
DEVELOPMENT NO
PLAN CHECK FEES $