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HomeMy WebLinkAboutX2021-3098 - Permit ApplicationComm'I [-Building Grading clul Of Work /,Do �•••� vuaar rermit APPUCation City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X2 -0_L'_3' J.. DrainageElec address) 1- Flood ---__ V New/Add SF � Remodel SF Gara e/N Cu Yd cut Cu Yd Filll lum I L Fire (- Liq f— Landslide j -N/A Floor Suite No Use # Storiell rirr # Units (if Res) W emmu Material/Labor) ✓I (y OWNER'S NAME I (/ Last �- Owner's Address - First — 5 Owner's E-mail Address - - City_ - Zip Z( G-3 Telephone__ APPLICANT'S NAME- First �_ �3 �f Last -- -' - Applicant's Address -_--- — Applicant's E-mail Address - - - City State �— --- Zip � --- --- — ARCHITECT/DESIGNER'S NAME Telephone Last Architect/Designees Address - First ��- -- --- Lic. No. �--- Architect/Designer's E-mail Address City - - -- - - - - -Zip �— - _.. Telephone.— ENGINEER'S NAME Last yv Scj�c W Engineer's Address First )CtS�,^ Lic. No.�— - - t� )r Engineer's E -mall Address 7 ? _ ti f {"c) OLCA [ i v city' T v'I� state - - - - tC-%s CieGorn__ --- __ Zip Z L i Telephone r�ci CONTRACTOR'S NAME/COMPANY ) i AM Lic. No. Contractor's Address 7i/ C Class Contractor's E-mail Address Cit _ �✓' State - Lam., r \ 6 Zip Cc'7 Telephon 7, c d SE BAGS REAR SETBACKS FRONT C) ETBAC SLEFT� PERMIT NO. i°Za�1-3648 SETBACKS RIGHT ,SE �O PLAN CHECK NO. DEVELOPMENT NO PLAN CHECK FEES $ 26G 0= s