HomeMy WebLinkAboutPV2021-037 - Permit ApplicationPrin 'Farm �i9®r oaf
for Combo �Llold'al� Scar pegli %iJd J k g pp Ication@N'V)
Comm'I esidentiaf e City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood [, Fire Liq [; Landslide F7N/A Floor Suite No
Description of Work Use Const Type °TO 62 0qA1 Lfr t
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OWNER'S NAME Last First �ee
Owner's Address Owner's E-mail Address
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_ State Zip Telephone
APPLICANT'S NAME Last_ ^ _ First
Applicant's Address Applicant's E-mail Address'
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City State [(!A Telephone
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ARCHITECT/DESIGNER'S NAME Last First Lic. No. F®
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Architect(Designer's Address Architect/Designees E-mail Address
City State ZipF—
Telephoner
ENGINEER'S NAME Las OMt� First f Lic. No.1aj/l
Engineer's Address r9 Ill „1 Engineer's E-mail ddress ,\�6
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City % 1. Q e - — State �j Zip Gj�t Telephoneg
CONTRACTOR'S NAME/COMPANY tic. No. Oj-:M2 ,'7 Class q4-
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Contractor's Address Contractor's E-mail Address
City �— State Zip
�Y Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO
USE ZONE DEVELOPMENT NO -� CN CHECK FEES ,$,,
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