HomeMy WebLinkAboutX2020-1335 - Permit Applicationk2o2c� � �33s ,�� i
Prlm Form Worksheet for Combo Building O Sosv lar Permt Application
Comm'I '[-] Residential
Building F J Grading
Project Address (N(
Description of Work
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New/AddSFF777
OWNER'S NAME
Owner's Address
F-07J-h
A-
Cityr
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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mailinq address) ❑ Flood I] Fire F-1 Liq n Landslide
Cu Yd Fill
[—jN/A Floor j Suite No
Use lIrROUo nst Type I 1
i -I— # Stories # Units (if Res)
Valuation $
Remodel SF Garage/New/Add �� Material/Labor J
Last
APPLICANT'S NAME Last
First
Owner's E-mail Address
State 56T_ l Zip
Applicant's Address
City _ State
PM
First s AIR
Applicant's E-mail Address
Zip Telephone _ _ �r L✓'J HCl
ARCHITECT/DESIGNER'S NAME Last - FirstU I Lic. No. L �j
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Architect/Designer's Address
I State j
City ---- U%'�_ly.�O:� __ __. i -.�C_�__,
Architect/Designer's E-mail Address
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Zipx,21 1� Telephone C,t4_Gi e�6�..4C,
ENGINEER'S NAME Last Fill[777777777Lic No.F-77
Engineer's Address
City - State-�
CONTRACTOR'S NAME/COMPANY _1 0 bF
Contractor's Address+v:i -
StateI
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Engineer's E-mail Address
II
Zip-� Telephone
Contractor's E-mail Address
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Zip Telephone—,
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $