HomeMy WebLinkAboutX2021-2526 - Permit ApplicationI _ Comm'I r Residential
City of Newport Beach - Building Division V
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(_ Building f- Grading FDrainage -Elec
Project Address (Not mailing addres
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I -Mach rplum CuvdCut
Cu Yd Fill I F
r Floodj— Fire j Liq r Landslide j—N/A
Floor Suite No
Use F Const Type r--
# Storiesr— # Units (if Res)r-
New/Add SFr-- Remodel SFr-- Garage/New/Add �— Valuation $
Material/Labor
- — _
OWNER'S NAME
Last
LLL
__ First
Owner's Address
- --
'- "-----
F
Owner's E-mail Address
.City
State
ZIP F, Telephone
-
APPLICANT'S NAME
Last �- — — -
First
Applicant's Address
Applicant's E-mail Address
City
State �— Zip r-- Telephoner--
ARCHITECT/DESIGNER'S NAME r--
Last First
Architect/Designer's Address
Lic. No. -
Architect/Designees E-mail Address
City
_.._ -
--
State ZIP Telephone
ENGINEER'S NAME
Last
First F Lit. No.r--
Engineer's Address
Engineer's E-mail Address
City
---
State Zip Telephone
CONTRACTOR'S NAME/COMPANY/}
t C (lv T /A - , Lic. No. iv j if `u Class
Contractor's Address
11�1
Fy;1
Contractor's E-mail Address
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n a: v- U Its e State C s
?E Zip L Telephone j -117 L 7 qct"
77
CKS REAR
LSETBACKS
TBACKS FRONTMC3?oEj PERMIT NO.
LEFT
NE
BACKS RIGHT PLAN CHECK NO.
:DEVELOPMENT
NO PLAN CHECK FEES $ 3� Z--- ° 76