HomeMy WebLinkAboutX2021-0582 - Permit Application (2)' P,rim o�m '" 'TNdrksh'eet fog"m
Cobo'Building'& Bd1ar PfFrrhit"A' pliCatiori a
Comm'I Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB IT
\Building rGrading F -Drainage F_.Elec r,Mech rPlum Cu rd Cut F_ Cu Yd Fill
Project Address (Not mailing address) [' Flo o Liq F'i Landslide 1 -N/A Floor Suite No
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of Work
New/Add SFF Remodel SF
OWNER'S NAME Last
Owner's Address
Use Const Type
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1 d # Stories7___,�Units (if Res)F
Valuation $
Garage/New/Add F Material/Labor 0^
First I c d if it(
Owner's E-mail Address
1 2 SPI &7,g��Y I_
City F(Vtti u�J'a27p���r State CQ Zip �ZpU Telephone
APPLICANT'S NAME Last
Applicant's Address
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First
Applicant's E-mail Address
City ? State C66 Zip ! ��d Telephone
ARCHITECT/DESIGNER'S NAME Last I L jGH ?
Architect/Designer's Address
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City I &mii� rar r *iAe-,/4 State < n
!i First Cf}l (_4 Ad' Lic.No. I _LZ40
Architect/Designer's E-mail Address
zip q- Telephone
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ENGINEER'S NAME Last First IF)P07L Lic.No. q62z7/
Engineer's Address
City li/-9- ncG hh State I
Engineer's E-mail Address
Zip TZ Bay Telephone W -q 3 -- -11717
CONTRACTOR'S NAME/COMPANYjcylVo. D� Class
Contractor's Address
City �— State
Contractor's E-mail Address
zip Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ ��