HomeMy WebLinkAboutX2020-1978 - Permit Application..v1 na[JccL wI vvinuU 92UJIU1119 at oOlar r'ermill Appilication
F- Comm'I Residential City of Newport Beach -Building Division XRO�?p •)
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
:j 1912116 F-`2
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New/Add SF
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Valuation $
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OWNER'S NAME
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Owner's Address µ 0'e,� t Ad /
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City
State I Zip � Telephoned---
APPLICANT'S NAME
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Applicant's Address
Applicant's E-mail Address
City I
State F Zip [ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last' �nPipN FirsterZI, — �—
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
5500 E. Qkscr-ttrJa.w.✓ s> -
City Bo%St
State :C9 Zip 83i1Z Telephone gtig_209.8g83
ENGINEER'S NAME
Last'. First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State �— Zip F- Telephoner
CONTRACTOR'S NAME/COMPANYLic. No. / b 2%3 g$Class
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Contractor's Address
Contractor's E-mail Address
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State Zip270
1 Tele phone 9 X73 -2z zZ Ex. 3
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ��J t� %{►�
USE ZONE
DEVELOPMENT NO ` UIV -OW4 PLAN CHECK FEES $