HomeMy WebLinkAboutX2021-0037 - Permit Application (2)IWP
m ; Print Kor p Worksheet for GoMbo Building .& S®lar:PerMi�tAppl'ication R
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r Comm'I (r Residential City of Newport Beach Building Division £
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood F_ Fire F_ Liq (` Landslide FN/A Floor Suite No
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Description of Work
Use Const Type
# Storiesr— # Units (if Res)[—
New/Add SFF_ Remodel SFF— Valuation
Garage/New/Add F_ Material/Labor Fy� L��U
OWNER'S NAME
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Owner's Address
Owner's B-mail Address
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City Int)1Zl,FYt<i✓i a. State
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APPLICANT'S NAME Last
p'ts� EZ- First
Applicant's Address Applicant's E-mail Address
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Citylrtt, ,)��: ,}r State �. Zip .J Telephone 1%2 ' ! 1 1�
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ARCHITECT/DESIGNER'S NAME Last
First �� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City _ � State ZIP �— TelephoneF—
ENGINEER'S NAME Last
First Lic No.�� ,
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Engineer's Address Engineer's E-mail Address
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City F'
State �� ZIP �� Telephoned
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CONTRACTOR'S NAME/COMPANY Lic No. �— Class
Contractor's Address Contractor's E-mail Address
City I State �� Zip F_ Telephones
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SETBACKS REAR
SETBACKS FRONT f7
,' PERMIT NO. L ' C773.7
SETBACKS LEFT" SETBACKS RIGHT PLAN CHECK N0.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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