HomeMy WebLinkAboutX2016-1053 - Permit ApplicationX2-�ItQ' lOS3 C� ��
Worksheet for Combo Budd[ing olar Perm Application
n Comm'[ sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE At TIME OF SUBMITTAL
TBtl.lding jGrading r]Drainage "Flet OMech Plum" Cu Yd Cut Cu rd Fine
t Address (Not mailing address) J71 Flood 1C Fire [7 Liq rf Landslide EIN/A Floor, Suite No
Description of Work T — � 322
Use F45� Ki Const Type
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CDwS/72G(C% # Stories[T- Units (if Res)n
New/Add SFL Remodel SF[_, �i Valuation $ Z01,Garage/New/Add I—} Material/Labor
OWNER'S NAME Last
�� --- -- First,
Owner's Address Owner's E-mail Address J, 62/
2ZZZ , �E'v Sl _' ._ I �_ %el« is is 2v�'O. C ��'►1
City(/– State Zip / Z %y0 Telephone /5%✓d�{�//
APPLICANT'S NAME Last�� First ��
Applicant's Address Applicant's :E-mail Address
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City, ���iif� State Zip
ARCHITECT/DESIGNER'S NAME Last First
/.c�rvv /% Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
City — State�I Zip Telephoner
ENGINEER'S NAMELast — First Lic. No.
Engineer's Address Engineer's E-mail Address
Telephoner -77-7-7-77
City _ _ — J State Zip
CONTRACTOR'S NAME/COMPANY Lic. No. W Klass
Contractor's Address Contractor's E-mail
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City/(/� /�__ — State _J Zip ` Telephon
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT ` PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $