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HomeMy WebLinkAboutX2021-1361 - Permit Application (3)i/' comm I I Residential city or Newport Beach - Building Division �j( NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL v o (,?Building r Grading Draina a r 8 j— Elec r Mech P4oject Address F Plum G vd Ut� (Not marling address Cu Yd Fill - g ) [- Flood ( Fire j` Liq r Landslide LL } �`y� j Floor s Suite No Option of Work j------ ! j {: 4"t r' /a r 1 8n �t ti.'2 i :� r a Use v -ti nst Type P }i'd sty i" `�- Co(, t `^ 0ft 1.5 k ✓ j J ,,: Stories New/Add SF i r #Units (if Res) Remodel SFF- s.¢ Garage/New/Add Valuation $ OWNER'S NAME Last ^ � ' Material/Labor ' > Owner's Address First t �t 4 J Owner's E-mail Address y City _ _ State APPLICANT'S NgME - Zip - 3G ' e,2 Telephone ' F y i£ `e N Last _ s Applicant's Address First '+ i!,• >_ ,Yrs 1 fa ft 5 APPhcantsEmailAddress City , o S v a � � �� {' /l /y ✓' .., State _ ,I --tea RCHITECT/DESIGNER`S NAMELestZ p L I / rKV1 `10 >` Telephone t. . r fr ti,�' r'rl - I Architect/D esigner's Address s`� } °' First �� Lic. No. r " ; ; , Ili ; , f Architect/Designer's E -m a } L_. ail Address City psit8G•-i 4 State.,- Zip {'� �� Telephone �§ { ENGINEER'S NAME { j Last ff ° Engineer's Address First Lic. No. Engineer's E-mail Address S City State Zip— Telephoners CONTRACTOR'S NAME/COMPANY ,- � � �qI Contractor's Address ¢ r AMI IN Lic. �D No. IVI/I(p� lI g ry ! 2 cuss n � Contractor's E-mail Address t city � U A j State: /qq,',"w�j6.9 A _ /_ n C (P'A. (VM j zip 'IZ ®�Go Telephone dQ(ag, °r b SETBACKS REAR..r��( I SETBACKS LEFT SETBACKS FRONT I USE ZONE SETBACKS RIGHT -` PERMIT NO. DEVELOPMENT NO PIAN CHECK NO PLAN CHECK FEES $