HomeMy WebLinkAboutX2020-1886 - Permit ApplicationPrint Form Mid rhC q) eet for Cor-rilbo r8luHG nig % SOW Por�rir�o� A ppficatio n �E.wPoR
City of Newport Beach - Building Division X V�( 0 - I ? 0
(W Comm'I Residential �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ;roµ
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Pwoject Address (Not mailing
address) F_ Flood FW Fire F- Liq r— Landslide F"N/A Floor Suite No
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Description of Work
Use Const Type
-12,
,4
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#Storie# Units (if Res))
Valuation $
Material/Labor Ia f(Syfs'YJ
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New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last r ��—/D
First
Owner's Address _
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Owner's E-mail Address
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City 6 �/�
State Zip 7,62 5 Telephonel (71 V 7 - 31Q)
APPLICANT'S NAME Last �J
775Z First �
Applicant's Address
Applicant's E-mail Address
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City t L L M fN%
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State �`,� Zip i Telephon to ,6- G
ARCLIITECT/DESIGNER'S NAME
Last Fi First r
Lic. No. I -
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State I Zip-� Telephonel
ENGINEER'S NAME Last I
First Lic. No.I
Engineer's
Engineer's E-mail Address
City F
State Zip Telephone
CONTRACTOR'S NAME/COMPANY
.1�1 /�A1� Lic. No. Class
J `
Contractor's Address
Contractor's E-mail Address
City
State I� Zip 12 TelephoneQ
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBA
CKS LEFT SETBACKS RIGHT PLAN CHECK NO.