HomeMy WebLinkAboutX2021-1105 - Permit ApplicationPrint Form I GOU1100 U kdc)Jon (VA 30as ' VlermK Appho-odiorl ��W °Rr
j` Comm'I Residential City of Newport Beach - Building Division t-1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI-- % \ c\G'i
kBuilding F Grading F-Drainage F Elec _ Mech (Plum CuvdCut CuYdFill 17,
Project Address (Not mailing address) f Flood F Fire j� Liq r Landslide F_N/A Floor Suite No
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escription of Work
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Use Const Type
A # Stories # Units (if Res)
47
e Valuaiion $ 41
New/Add SF Remodel SF I Garage/New/Add Material/Labor
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
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Firsts
Applicant's Address
Applicant's E-mail Address
City _ 1 /
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ARCHITECT/DESIGNER'S NAME
Last — First e
Architect/Designer's Address
Architect/Designer's E-mail Address
City -t,
State, Zip %�� �.s ` °.j Telephone elq
ENGINEER'S NAME Last
C.k-`first Lic. No.try
Engineer's Address
Engineer's E-mail Address
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State �— Zip � � -1 ��'� Telephonel 414,q TZ-_W'' 6alsv
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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City -; __
State �— Zip 1g2,jg1 Telephone '1 tvtv(�—
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. XWO
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $