HomeMy WebLinkAboutX2019-2455 - Permit Application( Worksheet for Combo Building
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CommI j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_BuildingF` Grading [—Drainage [ Elec ("Meeh i Plum CU Yd Cut cuvdFill Fi
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq i` Landslide 'N/A Floor Suite No
Description of Work
Use I Const Type
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# Stories, # Units (if Res)F-!
Valuation $
Material/Labor
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New/Add SF�� Remodel SF— Garage/New/Add �!
OWNER'S NAME Last-�'-j�J ,.� GL�J First
Owner's Address
,� Owner's E-mail Address '
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city /\�r--,7� _ State . zip
iJ . Telephone
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APPLICANT'S NAME- Last �First G�Js
Applicant's Address Applicant's E-mail Address
City F,F.nGLe!� ��ieay,�:n-.J.,� _ State .Zip ^ � Telephone (
(9c ) CY
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip r Telephoned—�
ENGINEER'S NAME Last First G71._ Lic. No. �"•__/}�?c�
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Engineer's Address Engineer's E-mail Address
City State zip r. / �
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`i� Telephone (71�l,'y')
CONTRACTOR'SNAME/COMPANY �```7 — : Lic. No.
vs •�'✓rye C��?� nc,. `a`//il, Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. z,0A
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $