HomeMy WebLinkAboutX2021-2911 - Permit ApplicationPrint Fofm
worksheetfor Cdinbo'Bu!Fding&-Sbitepbrniit-/Application
F COmm'I <ResidZt'ia'1q All" City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
bulldlng T_ Grading F.. -.Drainage V-Elec Mech ),ZPlum C MoL.
u Yd Cutl Cu Yd Fill F
Project Address (Not1Mailing address) F Flood
1�-,H Fire F7 Liq r- Landslide 7N/A Floor Suite No �KO+orp
Description of Work
Use F Const Type
# Stories
# Units (if Res)r
New/Add SFF� Remodel SFF—Garage/New/Add Valuation
Material/Labor
OWNER'S NAME Last I -�I L IJ U) - Y) JCC Firstj e Lr
Owner's Address
Owner's E-mail Address
State zip
city
FIT��Zp Telephonerc/.u/ 17, 17",
APPLICANT'S NAME Last
Applicant's Address
First
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3-1T bec, C
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Applicant's E-mail Address
City _P)e ol Ck
State Zip
[CtO,�:Y� Telephonef,(,Y-�
ARCHITECT/DESIGNER'S NAME
Last F�
First
Architect/Designees Address
Lic. No.F�
Architect/Designer's E-mail Address
City
State Zip
Telephone
ENGINEER'S NAME Lastt
t> First Lic. No.
F8
Engineer's Address
✓
Engineers E-mail Address
City
StateF
Zip [, TelephoneF_
CONTRACTOR'S
CONTRACTOR'S NAME/COMPANY
Rol au -_�tro Lic. No. 5�22 Class r
Contractor's Address
3_�kv�
Contractor's E-mail Address
City
State 7— r
F zip fTtL--s-7,,--,eIephoneJ -&S'l C-_�
SETBACKS REAR
SETBACKS
SETBACKS FRONT
PERMIT NO. 2-11
LEFT
SETBACKS RIGHT
USE ZONE Tr�_ DEVFl nPRM:K17 kln PLAN CHECK NO. Z_,�5