HomeMy WebLinkAboutPV2019-188 - Permit Applicationa m
E] Comm'I ❑ Residential City of Newport Beach- Building Division � �'r 9
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL_ c�
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Building ❑Gradingainage Elec ❑Mech f7 Plum CuvdCut vdR[IE7
Project Address (Not mailing address) ❑ Flood ❑Fire ❑ Liq ❑ Landsli Floor Suite No
Description of Work
Use 1-1 Const Type 1-11
# Stori # Units (if Res
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Valuation 5
Material/Labor I
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New/Add SF =L- Remodel SF Garage/New/Add
OWNER'S NAME Last �� e First , 1
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Owners Address V r Owner's E-mail Address
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City' LOV,0V A ��..Vy A State .Zip Telephone , Z
APPLICANT'S NAME Last �f���� First
Applicant's Address Applicant's E-mail AddressIA
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CityU ��� State l I .1L y- Zip Telephone
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ARCHITECT/DESIGNER'S NAME - Last i i First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State ZIP r— - Telephone '
ENGINEER'S NAME�'
Last,l�, First � Lic. No.
`Engineer's Address Engineer's - ail Address "
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City State Zip Telephoner
.CONTRACTOR'S NAMEKOMPANY Z Lic. No. j P Class ( l�
Contractors Address - Contractor's E-mail Address
City t` State Zip i Telephone r
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT ' PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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