HomeMy WebLinkAboutX2016-2540 - Permit Application",' xn F y' E. r Worksheet for
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F6uilding (/Grading
Project Address (N
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Description of Work
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City of Newport Beach - Building Division ' '
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL --X `"1 n G''
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El Flood ❑ Fire C Liq [ Landslid /A Floor f Suite No
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New/Add SF cj i, (p rj Remodel SFF-7-77 Garage/New/Add
Use IAConstType IU7
# Storiesl i" l # Units (if Res)7
OWNER'S NAME Last 12 !72 15 �I— p�, fi ,,�i-�'v-ee,-}... (,A- G
Owner's Address Owner's E-mail Address `
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City C WVer State Zip L„O 60 Telephone Cq4�, 4.C.A�%
APPLICANT'S NAME Last
Applicant's Address
City State
First
Applicant's E-mail Address
Zip �� Telephoned
ARCHITECT/DESIGNER'S NAME Last Firstev. of Gt WCV
l 41_ Lic. No.
Architect/Designers Address Architect/Designers E-mail Address
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City V 'Qjrta�d� State FGft Zip C(7j l ��y� Terlephone
ENGINEER'S NAME Last 1 5 1 \QA,
Engineers Address
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City r� N' ,V,&; ' State
First Lic. No.
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Engineers E-mail Address
Zip Fit Telephone '%® ', 7 ) ® /
CONTRACTOR'S NAME/COMPANY . I I Lic. No. Class=
Contractors Address
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City'.. State
Contractors E-mail Address
Zip CAI TelephoneF777�',
SETBACKS REAR SETBACKS FRONT �'—bglt
SETBACKS LEFT SETBACKS RIGHT X �7-6411
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $