HomeMy WebLinkAboutX2016-3448 - Permit Application (3)1
Worksheet for Combo Building la & Sol )(20*1�0 -
F_ Comm'I Residential City of Newport Beach -Build' Permit Application
wilding Grac
Project Address
Description of Work
NOTE: PLAN CHECK FEES DUE AT TIME 'VF�f RESOURCES DI
19 Drainage I—Elec
I" Mech Plum O
Cu Yd c "ITYr NIFIWpil�RT BEACH
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7/" r 1 ,.1 n t� r I No
1
Use I Const Type F_
# Stories #Units (if Res)
New/Add SF �
Remodel SF�---
�� Garage/New/Add Valuation $
I
Material/Labor
OWNER'S NAME
Last
Owner's Address rim First
Owner's E-mail Address
City
J' u ✓ / �( State '
APPLICANT'S NAME Zip Telephonelc
+ —�'�-
Applicant's Address past First
I[ Applicant's E-mail Address
City u._._ �— F --------�x�
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State �
ARCHIrFrrinr�l�..�..._ Zip � I Telephone� �m s��
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Last
Architect/Designer's Address
City
ENGINEER'S NAME
Engineer's Address
City
Pl1111Tn _
First
Architect/Designer's E-mail Address
State
FL Zip Telephone
-------------
Lic. No.
Last � u
��
e n First Ann t ._
"� ` V V �,\ Lic. No.�
---� Engineer's E-mail Address
State Zip �— ---�_
Telephone
---- • ••^� 1 %jR a IVHmE/COMPANY -
Contractor's Address Lic. No. � � Class,
-�� 3Contractor's E-mail Address
City
(1 / d t� r � 4-/ �� � State 7X-
SETBACKS REAR
SETBACKS LEFT
USE ZONE
Zip Telephone
SETBACKS FRONT
PERMIT NO.
SETBACKS RIGHT
PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FFFG 19 1 1 T1,