HomeMy WebLinkAboutX2021-3393 - Permit Application (4)r .�
.- 6ullar Veradt . PPlication
NOTE: PLAN CHECK FEES SUE AT TIME OF SUBMITTAL
I- Comm I r Residential City of Newport Beach - Building Division ° <'M�
F-Building r-Grading F-Drainage -Elec r-Mech ° r
Plum CuYdCu[� CuYdFill�
Project Address (Not mailing address) 1- Flood r Fire r Liq r Landslide 1-N/A Floor
_ 1 _ (9 l�-w C, s PP. Suite No
_ F
Description of Work e
Use F— ConstTypeled
�—
cw
#Stories #Units (if Res)
New/Add 5FL6 Remodel SF /V� Garage/New/Add Valuation $
-- � Material/Labor ?
OWNER'S NAME Last
® �-�-.�+ri-s— First
-
Owner's Address -
Owner's E-mail Address
City State-
---- Zip �— TelPnhnnc[__�
APPLICANT'S NAME Last S� L
First
Applicant's Address
Applicant's E-mail Address
�-� - --� 7 Aj /C
City State
�)�� - Zip Telephoner ;'� �^
ARCHITECT/DESIGNER'S NAME ast
q ����� A S (FYI Lic. No. �—
Architect/Designers Address N Architect/Designers E-mail Address
City
State r Zip Telephoner--
ENGINEER'SNAME Last
L� _ First F7H�z?sms Lic. No.
Engineer's Address Engineer's E-mail Address
City p�VIA/State F Zip L (o�CJ Telephone /7G% 77 �
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
State �—
SETBACKS FRONT
Lic. No. F� Class f —
Contractor's E-mail Address 7 S14 6
Zip r— Telephoners®
-oiir7
PERMIT NO. 4%Z/Zkg,/5
PLAN CHECK NO. )C % 6)7 i
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK FEES $