HomeMy WebLinkAboutX2017-3082 - Permit ApplicationEss uc 'pt QeQ IL o r\ X2,o �1-
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Worksheet for Combo Building & o ar Pe mit Appl cation
City of Newport Beach - Building Division 3
F comm'I Vesidential NOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL uFoa"
Kuilding F_ Grading rDrainage rElec rMech F_ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r Firer Liq r Landslide rN/A Floor Suite No
6 6
29alrA
Description of Work
Use 6 Const Type 6
If Stories If Units (if Res)
t,)E\,, p,e>;�Ac i �( raa, ,,�,�tt po
,O O
Valuation $ C
Material/Labor �j-&V V
New/Add SFF— Remodel SF �— Garage/New/Add r----
OWNER'S NAME Last CD- First Art G
Owner's Address Owner's E-mail Address
2qn ( 'S7_
city ! IJ6W {bILT-P�C.Ei- _.. State C4-._ Zip � 660 Telephone VO -877-70"t'?
APPLICANT'SNAME Last ko RZ First IA) 6S
Applicant's Address Applicant's E-mail Address
$QS bOV(F GT_ IW6SKJJ�2 i� cord
City Ney�y g�A( State 14,Z zip[ Telephone g4S1$055Zq(
ARCHITE ESIGNER'S NA Last First Lic. No.
Architect/Designees Address e 5 C �I M ArchitecUDesigner's E-mail Address
City �— State F Zip F TeiephoneF
ENGINEER'S NAME Last pox EIV(�tfjEF4vJq First Lic.No 7i��
(
Engineer's Address Engineer's E-mail Address
11 o C N, '-I"uSrt rJ WE-
City I AmAw6li-k State Com Zip FqM07 Telephone 71(-(-63o-Q00
NAME/COMPANYLic. No. FqR8?6 Class c-36 e53
CONTRACTOR'S
Contractor's Address Contractor's E-mail Address
Fq�bav e- �Tp . f 4, �5 Aoo (s °� •44za W
City t �--� O.r.AC i-.. State RZ— Zip _..02,660 Telephone ,.7(r{._3�%`"I.�SS
SETBACKS REAR 60 SETBACKS FRONT %O r G I PERMIT NO.
SETBACKS LEFT (p r SETBACKS RIGHT PLAN CHECK NO.
-1
USE ZONE -� �p iJa O DEVELOPMENT NO 1 � j� b f U PLAN CHECK FEES $