HomeMy WebLinkAboutX2021-1960 - Permit Application1- Comm'I r Residential City of New
NOTE: p port Beach -Building Division � y, f
LAN CHECK FEES DUE AT TIME OF SUBMI Ai� Y ✓ �uI
['Building j Grading
Drainage F-Elec rMe
ch
Project Address 9 Plum Cu Yd cut
(Not mailin address) F Flood Cu Yd Fill
Fire F Liq r- Landslide rN/A Floor
- Suite No
Description of Work
Use Const T
- ype
-
ew/Add SFF__# Stories
- #Units (if Res)
N— Remodel SF -
-
Garage/New/Add
/Add Valuation $
OWNER'S NAME Material/Labor
Last
Owner's Address First
Owner's E-mail Address
City -
- State
ZIP
APPLICANT'S NAME _ __- Telephoner�'
Last -
Applicant's Address - First
Applicant's E-mail Address -
city
State
�— -
ARCHIYECT/DESIGNER'S NAME Zip Telephone -
Last
Architect/ -signer's Address First_--
Lic. No. �.
Architect/Designer's E-mail Address
City
-------
State-
-- Zip �—_ -
ENGINEER'S NAME TelephoneF _. _
Last i
Engineer's Address First
Lic. No.
Engineer's E-mail Address
--
City -
State
Zip Telephone -
CONTRACTOR'S NAME/COMPANY
�VJDSIt�I;l�iN
Contractor's Address �l �'�IN° Classy
d ft ! 1 Contractor's E-mail Address
city 6 � � , I� d 6 ��� � �'��tJ� -
State IC/t'"C Zip
o 2Telephone -
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT -- PERMIT N0.
USE ZONE_ PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $