HomeMy WebLinkAboutPV2021-113 - Permit ApplicationF Comm'I 'Residential t X-;' City of Newport Beach - Building Division '/ J(4 Vl J C4 Glt),107 'g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
;Building [;Grading r -Drainage [;Elec ;Plum CuvdCut cued ill
Mech
Project Address (Not mailing address) [7 Flood F_; Fire C; Liq F Landslide C!N/A Floor Suite No
Description of Work Use F Const Type V-3
- -- ���-
vv
#Stones�i #Units (if Res)
�t 1 V l ✓! l flu D'z vt//�1 ��
�rli�_ rmarco_�rn
1� Valuation� D/G
New/AddSF� Z Remodel b Garage/New/Add - Material/Labor
OWNER'S NAME Last First jagon
Owner's Address Owner's E-mail Address
City StateZip - _ - -
d!' - l Telephone
APPLICANT'S NAME Last peer/y)-cc)0 l c l� 1,rt too Ll/¢f IZfj2
Applicant's Address
City ���" nim State F5i_
ARCHITECT/DESIGNER'S NAME Last
Arc
hi
te
c
t
/Designees Address
.----.._._
City State F
Applicant's E-mail Address
�r 2 12 4qtlYI--("✓-6)
- -- -
Zip7� Telephone
First �Ql %� Lic. No. F I(V
Architect/Designer's E-mail Address
- M
ZipF Telephoner
ENGINEER'S NAME Last First Lic. Nof —'
Engineer's Address
City State I �"
Engineer's E-mail Address
✓hrYi�>7oleC� f�t�vcil'�CS- carr,
Zip Telephone
CONTRACTOR'S NAME/COMPANY _ ,-w� /tet;Lic. No.gyq Zbs• Class
Contractor's Address
`Pity EP f-: >, 21tr C>\A State FCit
'ACKS REAR SETBACKS FRONT
YKS LEFT SETBACKS RIGHT
E DEVELOPMENT NO
Contractor's E-mail Address
69/= GO Ns Thi) (�;n 2S
Zip F2 i 9 y Telephone / T �- 2 7 1_ 31
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
1601- tvim