HomeMy WebLinkAboutXR2022-3194 - Permit Applicationf�Form
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—, rint i - Wo.'Asfyeetfir.k-ulldhog=3 SularcRertnii Appltcation I— COmm'I r Residential City of Newport Beach - Building Division.
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j- Grading [—Drainage j—Elec r Mech Plum
Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) [- Flood r Fire F- Liq f Landslide rN/A Flo
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ascription of Work
New/Add SF�—
OWNER'S NAME
_ or Suite No
E—�MGiGy Use 5PD ConstType
# Stories # Units (if Res)
Remodel SFF — Garage/New/Add F — Valuation $
Material/Labor l0, C7tS�
Last I J b R-KI S o N
Owner's Address
200I VIS(% �JO
City
First I �O L
Owner's E-mail Address
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State r C Zip 9Lip�nO
APPLICANT'S NAME b
Last 1 UTJv� f�N
First
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Applicant's Address I wt w�i\t
33 pD V `� ��(V I U I TE Applicant's E-mail Address
ka,v�eri � }� 2 e S t I V! G, ca Vim+ City 1=Lv C' t I
_ I I T 8 �Gfi state �— -
Zip c�q� 3 Telephone 9- F. 230 —Gl'-✓ 7 O
ARCHITECT/DESIGNER'S NAME
Last �' U'�yi First �—
ArchitectiDesigner's Address Lic. No. �—
Architect/Designer's E-mail Address
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City I7
I T ��tG'f{ State -
- } Zip � Telephon cl4q, 230—�O
ENGINEER'S NAME Last
First Lic. No.F —
Engineer's Address
Engineer's E-mail Address
City
State � Zip � Telephoned
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Lic. No. � Class r—
Contractor's E-mail Address
City I State �—
Zip Telephone
SETBACKS7REAR SETBACKS FRONT
SETBACKS PERMIT NO.
SETBACKS RIGHT PLAN CHECK N0.
USE ZONE �
DEVELOPMENT NO
PLAN CHECK FEES $