HomeMy WebLinkAboutX2021-2271 - Permit ApplicationPrint Form
JX,Comm'l` rX
Worksheet for Combo Building & Solan Permit Application
Residential City of Newport Beach - Building Divisiont
NOTE: PLAN CHECK FEES DUE AT TIME nF Rl iRMITToi
[XBulldln9 r Grading
rDrainage jX Elee rX Mech [X Plum C,vdCut r� Cu Yd Fill r—
Project Address (Not mailing address) fx Flood F Fire [x Liq FX_ [xN/A Floor Suite No
Description of Work
-
Use Const Type r�
!"JSPArtc�2�T/aa®
w�arN rE�Cat�iNnr� (rr- 6kt/+6,f
-#
Stories # Units (if Res)
/SID 1 ®PiG �1an1� uax//v/$r>�
O/�D.c�r�v3�cn+► ' �+ -G''x®'!Z�'
aluation $
Material/Labor 7iO��
New/Add SF®e 7.5
RemodelSF�—�----- Garage/New/Addy----,
OWNER'S NAME
Last jy�J11e11F_ C%Nw0t94V1( First
Owner's Address
Owner's E-mail Address
�((i NN Tic
P0-
City -FfLr%I
State -
Zip `2617 Telephone 41-7Zo-31c)®
APPLICANT'S NAME
Last FR E[Cti First F(�
Applicant'sAddress
Applicant's Address
"E-mail
y�
K9&i 177,2D .fQIL•
City NQ HOLLgW®s9
State F C4 Zip q(607 Telephone a/$ G?i•58' J
ARCHITECT/DESIGNER'S NAME Last First F -----—-
Lic. No. F—
ArchitecUDesigner'sAddress
Architect/Designer's E-mail Address
City
State r--_.-.— ZIP sem— Telephonel
ENGINEER'S NAME
Last F First Lic. No.r_-----
Engineer's Address
Engineer's E-mail Address
City _
State F_ Zip F_ Telephoner—.----_--
CONTRACTOR'SNAME/COMPANY pjfj( ('I6NS C' ,/1 Lic No. 81)074 Class ���
Contractor's Address
Contractor's E-mail Address
_673N76266,
City i19 Ho ((`(/®®i�
State Zip r(7/607 Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT N0. Z,07 ,t - &Z7'
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ( j 6Z -
USE ZONE
DEVELOPMENT NO 0 ZOZi - 0 L16 7 PLAN CHECK FEES $