HomeMy WebLinkAboutX2020-0536 - Permit Application (4)Worksheet for Combo Building &polar Permit Application
City of Newport Beach - Building Division S3 W
Comm'I (� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL x����~�
(, Building (� Grading I -Drainage lec IyMech (r'Plum cuvdCut F CuYdFill
Project Address (Not mailing address_) Flood I— Fire F._ Liq I` Landslide C N/A Floor Suite No
Description of Work
Use Const Type
# Stories # Units (if Res) ,
p
�-� �Z.�'-f•C_ l/,�: � f ��
� is
Valuation $
Material/Labor
Y
New/Add SIF Remodel SF Garage/New/Add �
50
OWNER'S NAME Last —;Q5-1_MT
t h'�
First
Owner's Address
Owner's E-mail Address
State I 4
CityL � W :Vii S L) f& W
Zip Telephonel
APPLICANT'S NAME Last I"�pt(cN� First J®s
Applicant's Address
Applicant's E-mail Address
&X 5 e -'jonw ��
� q �rc�C=T @, a_Q 1, Co �•1
City � State
Zip %Vzj�_I Telephone 2, (r7ZZ-
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
I �r
Architect/Designer's E-mail Address
-
City 1 State �®
Zip �® Telephoned —�
ENGINEER'S NAME Last `TQY�e(C�
First I 17u✓ Lic. No.Ri u7a3
Engineer's Address
Engineer's E-mail Address 1�
02, C�ree,,,lea��
�'h2�f�,�c►.,_�eW�5���1��G�.�-
City W (,hR State
Zip 192 Telephones
CONTRACTOR'S NAME/COMPANY ..� Lic. No. 1����� Class0-
Uu
Contractor's Address
Contractor's E-mail Address
l tf ZZ %M�i y0� Ave'
j 60 �L)ij�dlrh,�n5 a i W-,&t,(� �ovs-
City C f D r M,(h7r State (,A
Zip (� Telephone �Z b' J2 -
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X %qJ2 t9 'L t,9'(0) ?j
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
PLAN CHECK NO. 2,gg10 ' qAc)n
PLAN CHECK FEES $ IyZO
DEVELOPMENT NO