HomeMy WebLinkAboutX2021-0271 - Permit Application' Paint Form Worksheet for Co X
Comm I mbo Building & Solar P M2 ( —GZ �� 0
FX Residential Cit on A
y of Newport Beach -Building Division ppllCation aE ro
R,Buildin NOTE: PLAN CHECK FEES DUEATTI
9 1-' Grading r 9 �X Elec I Mech jX Plum
ME OF SUBMITTAL
UBMITTAL
Project Address (Not MailingCu Yd Cutl
4527 Fairfield address) Flood N Yd Fill
_. � Fire r'-- Liq r Landslide
I—N/A Floor
Description ofWork �Suite
eNNo
�_ I
Remodel Master Bath. Replace fixtures and finishes. No exterior or structural work. �
—, Use R3 :Const Type I B —
New/Add
SF #Stories # Units (if Res) 7
Remodel SFr-----'
Garage/New/Add 7 Valuation $
OWNER'S NAME Material/Labor 0,000
Last Lilien ,
Owner's Address - -- First, David
527 Fairfield
City New
Owner's E-mail Address
- --
Port Beach
State Ca.
APPLICANT'SNAME ZIP 92625 Telephone 949-466-3919
Last Lushbaugh
Applicant's Address - - --- -.. First illiam
17191 Citron --
Applicant's E- - - - - --
- -. mail Address -
City Irvine ---- -_ -- -- - blushbaugh@aol.com
State Ca.
ARCHITECT/DESIGNER'S NAME Z'P 92612 Telephone 949-584-2166
Architect/Designer's Address Last Lushbaugh J -
First llliam
17191 Citron _ IF7Lic. No. C24867
Architect/Designer's E-mail Address
City Irvine blushbaughnaol conn
- State Ca - 2166
Zip 92612 Telephone 949 -584 -
ENGINEER'S NAME ---- �'
Last N/A -- --
Engineer's Address - - - First
Engineer's E-mail Address - -----
city
State �i
Zip �` _ _
-_Telephone
_.. `
CONTRACTOR'S NAME/COMPANY Telephone
Contractor's Address Lic. No.10,0407,01 Classy j -
�59� !n+ • � �� w a _ Contractor's E-mail Address
City I ��` Zip
-.. - StateI r� Ij —' IjI
Phone it 57� _ f
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT —�
--- SETBACKS RIGHT —� PERMIT NO.'7r I
USE ZONE
D LU `•� PLAN CHECK N0.
DEVELOPMENT NO , i
—_ PLAN CHECK FEES $ I j