HomeMy WebLinkAboutXR2024-1085 - Permit ApplicationPrint Form I Worksheet for Combo Building & Selarr_P_ermit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building r Grading F-Drainage r Elec r Mech F- Plum CuYdCut
F_ cuYdFill F_
Project Address (Not mailing address) F_ Flood r Fire F- Liq r Landslide F_N/A Floor Suite No
1��5 -6 L ecar & ild (7,1, W /- 3
,Description of Work Use F ConstTypeI/
%i. ( �'
'� # Stories t *ss (if es)F
Valuation $ v"
New/AddSFF_— Remodel SFF—- Garage/New/AddF— Material/Labor ®�
OWNER'S NAME Last (�U�� �f���TQ First
Owner's Address Owner's E-mail Address
eA
City N. K)Pop;� ZrI(j�&J 5 State Zip -3 TelephoneF—
APPLICANT'S NAME Last 'l J A L"D s First E_x)�
Applicant's Address Applicant's E-mail Address
gM C ro: toil
City ,61t�� State Zip C,5 Teaphone`�-[
ARCHITECT/DESIGNER'S NAME Last I 7 First Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City I State �- Zip I Telephoned
ENGINEER'S NAME Last �ra� Z First 1� v oe prr i Lic. No.F
Engineer's Address Engineer's E-mail Address I'L�
4 p l eLLA Sv l O
City Dp p P) � ?, State C j} Zip Ci� -} - Telephone ( 4- I y � ``i 5
CONTRACTOR'S NAME/COMPANY Y i C�S7po�1i6a 1 Ik)L_ Lic. No. Q(C( �1.& Class
Contractor's Address N� Contractor's E-mail Address
( 03 6 F-560Tq �f)j JN�u� Q, 5017�i tccrti A � Gt CitGyP15�VJC�i0�1 • C��
(�
City �¢(
lo[A � State �.�— Zip 'M,TelephonQ
tl• yii
SETBACKS REAR SETBACKS FRONT PERMIT NO. j1011 Z(4- loss
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $