HomeMy WebLinkAboutX2021-3409 - Permit Applicationr, rsesicential CRY or ivewport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Cf 'L -7(1®4 'F
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Project Address (Not mailing address) I- Flood r Fire (- Liq [- Landslide F_N/A Floor
Suite No
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Description of Work n r jI
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#Stories[ # Units (if Res)
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OWNER'S,NAME Last
Owner's Address
Owner's E-mail Address
City-
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APPLICANT'S NAME Last
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Applicant's Address 7
Applicant's all Address
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ARCHITECT/DESIGNERS NAME
Lasti�Q� First
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ArchitecttDesigner'sAddress I Lic.No.FXy°(�`
Architect/Desfgner's E-mail Address
City State �C '. -- - -
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- - Zip : � Telephone
ENGINEER'S NAME Last C
First ; /�af e� j Lit. o.
Engineers Address
Engineees E-mail Address " ✓
City - - StateZi- -
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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---AUKS REAR SETBACKS FRONT
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SKS LEFT SETBACKS RIGHT
PERMIT NO. ,
ZONE DEVELOPMENT NO PLAN CHECK N0. ' r �t '
PLAN CHECK FEES $