HomeMy WebLinkAboutX2021-2581 - Permit Applicationvvvll wW ✓ullullly a a7U1Q1 1-C1111AL P1IJ AFI.Q LIUII a¢r
City of Newport Beach - Building Division
F Comm'I r Residential J a s
NOTE: PLAN CHECK FEES DUE AT TIME OF su 3MITTAI "__,.
Building [Grading FDrainage [Flet F_Mech F.7 Plum cuvdCut F cuvdFiuF —
Project Address (Not Mailing address) F_ Flood F-Fige [7 Liq C Landslide F_N/A Floor Suite No
Description of Work
Use ConstType
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# Stories # Units (if Res)
_
Valuation $ --� r
New/Add SF �- Remodel SF Garage/New/Add Material/Labor
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OWNER'S NAME Lastf -I
1 _ First
Owner's
' Address Owner's E-mail Address
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city i J_i'_w L t)? ciN State Zi o G
_ / p' G D Telephone t`., % �� S
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APPLICANT'S NAME Last �<
C `lNG���1 .---- First_-.1����,�d;�'�
Applicant's Address Applicant's E-mail Address 1
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124
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City (t,�G, YI G L /�. Zip G L Telephone ��_
State 124 W. 4.G��I e
ARCHITECT/DESIGNER'S NAME Last � First
_ laic. No:
ArchitectIDesigner's Address Architect/Designer's E-mail Address
- - -
City State �- Zip �— Telephone
ENGINEER'S NAME Last F First F Lic. No.F77777
Engineer's Address Engineer's E-mail Address
. --
- --
City State F_Zip �- Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address V ;odtraetor's E-mail Address
-
city State �- Zip — Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $