HomeMy WebLinkAboutXR2022-2974 - Permit ApplicationLtrim Form Worksheet for Combo BuRding & Scpar Permit Application (14
°Cit of New ort Beach - Buildin Division
Comm'I j� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) C Flood r Fire [- Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F ConstType
# Stories # Units (if Res)F
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New/Add SF � - Remodel SF�� Garage/New/Add �-
Valuation a
Material/Labor I
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City State Zip F— Tel ephoneF—
APPLICANT'S NAME Last First, J
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Applicant's Address Applicant's E-mail Address
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City QePQ-%%$[ _ . _ -.-. _ State 7- Zip L!Z� d Telephone ?� D �i �T 7 _
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. �-
Architect/Designer's Address Architect/Designer's E-mail Address
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— -. - ---
City State I Zip TelephoneF—
ENGINEER'S NAME Last First �� Lic No. �—
Engineer's Address Engineer's E-mail Address
--- -
City State Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY lrle� Lic No. 7316 g [f Class
Contractor's Address Contractor's E-mail Address
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City QC�Ri1�<�a State R Zip R Telephone ?6,o
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SETBACKS REAR SETBACKS FRONT PERMIT N0. /l) R207Z- Z Q a
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. plc ZOZZ- Z'Sj Z
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $