HomeMy WebLinkAboutX2021-3288 - Permit Application (4)q - �z�
Rrin� i Form` Worksheet for Con ihn Rrrilrlinn k Snlar Par�mrt nnilinnfinn oa
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F7 Comm'I [ Residential City o. Newport Beach -Building Division
OTE:
PLAN CHECK FEES DUE AT TIME OF SUBMITTALo..
❑Building ❑Grading
--I 'age ❑ Elec ❑ Mech n Plum Cu Yd cut cued Fill
1
Project Address (Not mailing address) ❑ Flood _ Fire n Liq i Landslide ❑N/A Floor Suite No
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Description of Work
Use Const Type
54 VO
vk 0 9
#Stories #Units (if Ree s) F
II1J�V i
- -
aluation $ /
Materia /Labor
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New/Add SF��
Remodel SF Garage/New/Add
OWNER'S NAME
Last G_ a First
— — -- --- — — --- ----------J
Owner's Address
Owner's E-mail Address
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State _ __--- li Zip _ S'i 4� Telephone
APPLICANT'S NAME
Last Eo?1 First
pplicanfs Address
Applicant's E-mail Address
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State I,• -- Telephone- 7/•%2j)•-S/y�
--�—r ---� Zip �
ARCHITECT/DESIGNER'S NAME Last i First Lic. No.
ArchitecUDesigppner's Address
Architect/Designer's E-mail Address
City
_j State ZIP
ENGINEER'S NAME
Last �SL _ ___ _ First f ` ''' Lic. No.
Engineer's Address
Y1� Engineer's E-mail Address elf/
City
State Zip Telephoned',
ClassCONTRACTOR'SNAMECOMPANY _
--a— — --- -i +— D- -Lic. g
Contractor's Address
Contractor's E-mail Address161
City 13
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Zip- (ZG��j__J Telephone �r__Z7t
State �I
0 442l 27,
SETBACKS REAR
4
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT//� PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO P N CHECK FEES $ �
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CITY OF NEWPORT BEACH
COMMUNITY
BUILDING T DEPARTMENT
949-644-3200
PLAN PROCESSING REQUEST
ADDRESS:
DESCRIPTION: i510 Z
KAN CKEl
NEW ( OTC 1 APC 1 SUBMIT)
0 RESUBMIT ( recheck 1 process RFIU'R) yl (L
2 '— )
EVISION (delta pc hrs. —
,#
# of PAGES (plans 8% x11 )
BLDG STATUS: AP 1 PA I C PP
EMP STATUS: APIPAICOIPP
DEPTIDIV REVIEW NEEDED: (Circle requi
`
PLNG PW EMP HARBOR FIRE GRADING
Engineer:_ S• -- date:
Contact Name & #:
F.Mn XplenProcessingRequest