HomeMy WebLinkAboutX2017-2298 - Permit Applicationr
Worksheet for Cc
Cil
F Comm'l Residential NOTE: PI
wilding & Solar Permit Application l.�M
port Beach - Building Division
:K FEES DUE AT TIME OF SUBMITTAL
Fvl�wilding f- Grading (-Drainage F-Elec rMech
SETBACKS REAR
SETBACKS LEFTS SETBACKS RIGHT PLAN CHECK NO.
F_ Plum Cu rd cu<� Cu Yd Fill
Project.Address (Not mailing address) r Flood
F_ Fire j— Liq r Landslide =FN/A Floor Suite No
- -
l P+A VIA --
Description of Work
Use ConstTypes-
�Uv 6/14
# Stories # Units (if Res)
n C
f� J�'"pp'?yo �
•l
Valuation$ r D
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New/Add SF�— Remodel SFs--- Garage/New/Add,, Material/Labor
i
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State
Zip F— Telephones-- I
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
city State _Zip
q L. b TelephoneFr +1 .-mve'k
ARCHITECT/DESIGNER'S NAME Last
First— Lic. No.
Architect/Designer's Address
Architect/DesignWs E-mail Address
i
City State—
Zip F_ Telephones--
F LIC. No.F—
ENGINEER'S NAME Last
First
Engineer's Address -
Engineer's Email Address
City State
Zip �— Telephoner
CONTRACTOR'SNAMEICOMPANY � �f CXMC , ,' }( Lic.No. Class
Contractor's Address
Contractor's E-mail Address '
State �—
City )
Zip Q�, ZOV Telephone c 1 � m—
r� It
l- ll Al DMDRAIT nln
SETBACKS REAR
SETBACKS LEFTS SETBACKS RIGHT PLAN CHECK NO.
)(2011- 22q F2