HomeMy WebLinkAboutPV2021-091 - Permit ApplicationIX Comm'I r Residential U¢y or Newport Beach - Building Division 5202(
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA �!
[X Building FX_ Grading Drainage FX_ Elec r Mech r Plum Cu
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Address (Not (mailing address) Ix Flood r Fire FX_ Liq r Landslide r> -N/A Floor Suite No
Description of Work
Use r Const Type F
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C41'-0 � L44�Yl„2 ✓ �9' te #Stories #Units(ifRes)s
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New/Add SFF -- Remodel SF f --- Valuation
Garage/New/Add Material/Laa
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OWNER'S NAME Last vc� First VFY Y,
Owner's Address Owner's E-mail Address
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City Cc State r-- —
Zip [CA 21s;�7� Telephone ��I dL _Q,26(n C)"CEJ f_
APPLICANT'S NAME Last First o-eirn
Applicant's Address Applicant's E-mail Address
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City i4/�� State C Zip q Zi t� I . Telephone �. y 4 !J& ?> 07 L:0
ARCHITECT/DESIGNER'S NAME Last
First r �_- Lic. No. F_-.-_-
Architect/Designer's Address Architect/Designer's E-mail Address
'City State �-- ZiP�--- Telephone -
.ENGINEER'S NAME Last First Lic. No.F---
Engineer's Address Engineer's E-mail Address
City State I Zip---- Telephoner
CONTRACTOR'S NAME/COMPANY -V1 q T ��� CkV Lic. No. %✓ -1 j1-1,56 Class C
Contractor's AddressContractor's E-mail Address
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City Iry kIv`� State — Zip � L� Telephone `1'Z� �lyy>- r tc 1
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $