HomeMy WebLinkAboutM2021-0063 - Permit Application—�--�„ rn*neet r®r C�misc BLallrl7ay
Comm? r Residential M %/I)%/ Qb1QC .�OIBr Permit
y of Newport Beach - Application
r' - - NOTE: PLAN CHECK FEES DUE ATiTIME D.�.. //��
'Building [Grading V ,, � z
I Drainage F Elec a
Project Address C Mech [ Plum cu��i B®R
(Not mailing address
a u ) [I Flood [ Fire -
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--- _4 -� d of t No
Descri tion of ------ _
P Work -------'_-- !te
u (1 I-Q
6 t k Use ConstType
#
New/Add SF_' - ------ - ---- -- - - -
_J Remodel SF Stories? # Units (if Res)[—
Garage/New/Add Valuation$
OWNER'S NAME _ Material/Labor
Last �a _S S �-$-�
Owner's Address First --- - -
--- - -
Owner's E-mail Address ---
city _
State - (- -- -
Ts - - Zip
APPLICAN
NAME Last Telephone
F--"'-----------
Applicant's Address ----_ _._ First - ----
- -- - -_- -- Applicant's E-mail Address-------- - - -
city - -- - ---
- State - - --
-- Zip_
ARCHITECT/DESIGNER'S
NAME ----
Telephone
Last -
Architect/Designer's Address First ��
- - --- - Lic. No.
Architect/Designer's E-mail Address
City -- -- -
---- - State --
--- --- Zip �_ __ -- -- -- Telephone----
_
ENGINEER'S NAME
Last -
Engineer's Address L( First
_P(aut-2v-
LIC. No.pp[
�..�Engineer's E-mail Address
City (j
�UJ�LICUf� State.� -
CONTRACTOR- zip
'S Telephone
-
NAME/COMPANY
Contractor's Address `�'
a? -� Lic. No.67�� � Class'
Contractor'sE-mail Address
ity � . C State - �g I1��� i�M 3 v
FEW Zip 7 ,
I t .�o2-411
Telephoned
:TRACKS REAR
TBACKS.LEFT -- SETBACKS FRONT
E ZONE
SETBACKS RIGHT _ PERMIT NO.
DEVELOPMENT NO PLAN CHECK N0. �_I 2, L-
ECK FEES $ , i