HomeMy WebLinkAboutX2019-2448 - Permit ApplicationWorksheet for Combo Building - polar Permit A p cation �6WP�I
omm'I j 'Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1 1
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Suite
Description Of Work
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New/Add SF�
Remodel SFS' Garage/New/Add Valuation $.
OWNER'S NAME ( F Material/Labor
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Last I J
First
Owner's
Owner's Address
Owner's E-mail Address
city
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APPLICANT'S NAME-ast ��
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Applicant's Address
/� Applicant's E-mail Address
city
State s.. ,ss t 1, 24
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Last
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ARCHITECT/DESIGNERSNAME - 73"� Telephone 5
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First F —
Architect/Designer's Address Lic. No. �-------
Architect/Designer's E-mail Address
City
State —
?IP TelephoneF�v '
ENGINEER'S NAME --
Last I
°`- First G��'�
Engineer's Address r�SiNa..-rc. Lic. No. � -_ [�`��7u�' ,
Engineer's E-mail Address
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city
State ! �- Zi i P G1_ Telephone � 7lY�9`")"7— %/`rf✓`�
CONTRACTOR'S NAME/COMPANY
Lic. No.Class
Contractor's Addressj"" �—
��.) f.,. Contractor's E-mail Address
city
State7�.;
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SETBACKS REAR SETBACKS FRONT
SETBACKSLEFT PERMIT NO. q '
_-- SETBACKS RIGHT
- USE ZONE ----._ PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $
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