HomeMy WebLinkAboutX2022-1206 - Permit ApplicationWorksheet for Combo Building & S rplia ��6WPoa�
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL`5."�0 =
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New/Add SF��- e SF Sj Garage/New/Add �� -- Material/Labor
OWNER'S NAME Last / L j/%!liy -- First
Owner's Address Owner's E-mailAddress--"
City _.. �- State --_-.._ _.....
ZiP [_ TelephoneF—
APPLICANT'S NAME Last `7/Z -(/,A x First y
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME
Last A/�//�,C' J First /ZAw,p t/ Lic.N - 1L}2ZS
Architect/Designer's Address Architect/Designer's E-mail Address /
/ X /,I 06/ _-
City _._.. .._.,_State. �--� ZiP� Telephone(---._—_-_.-_._
ENGINEER'S NAME Last First �----..---.-.-- Lic. NoT_
Engineer's Address Engineer's E-mail Address
City State [_ Zip F_ Telephone��
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address �� � - --
City State �- Zip �i Telephone) 'AT, I ,
Il. �' �`7 e f -5 �
SETBACKS REAR SETBACKS FRONT PERMIT NO. ZO LZ ` t LV6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I �: �✓�,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 6